Hypertriglyceridaemia

Incidence increasing along with number of patients who are overweight or obese.

Associated with increased cardiovascular risk.

May cause acute pancreatitis when fasting levels >5.7 mmol/L (500 mg/dL).

Treatment includes lifestyle modification for all patients.

Statins are generally first-line pharmacotherapy in patients with triglycerides <5.69 mmol/L (<500 mg/dL) in the presence of ≥2 cardiac risk factors.

Fibric acid derivatives or fish oils are used as first-line therapy in those with triglycerides ≥5.69 mmol/L (≥500 mg/dL). They may be added to statins to achieve targets in patients with triglycerides <5.69 mmol/L (<500 mg/dL).

Hypertriglyceridaemia is defined by the National Cholesterol Education Program Adult Treatment Panel III as fasting plasma triglyceride level ≥2.3 mmol/L (≥200 mg/dL). Borderline high is defined as 150 to 199 mg/dL, high as 200 to 499 mg/dL, and very high as ≥500 mg/dL. [1] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) - executive summary. JAMA. 2001 May 16;285(19):2486-97. http://www.ncbi.nlm.nih.gov/pubmed/11368702?tool=bestpractice.com [2] Kushner PA, Cobble ME. Hypertriglyceridemia: the importance of identifying patients at risk. Postgrad Med. 2016 Nov;128(8):848-58. http://www.ncbi.nlm.nih.gov/pubmed/27710158?tool=bestpractice.com  Chylomicronaemia is present when triglyceride level is ≥11.3 mmol/L (≥1000 mg/dL). Guidelines from several national and international medical organisations regarding the determination and treatment of hypertriglyceridaemia use different nomenclature, yet are similar in their recommendations. [3] Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017 Apr;23(Suppl 2):1-87. http://journals.aace.com/doi/pdf/10.4158/EP171764.APPGL http://www.ncbi.nlm.nih.gov/pubmed/28437620?tool=bestpractice.com [4] Anderson TJ, Grégoire J, Pearson GJ, et al. 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2016 Nov;32(11):1263-82. https://www.onlinecjc.ca/article/S0828-282X(16)30732-2/pdf http://www.ncbi.nlm.nih.gov/pubmed/27712954?tool=bestpractice.com [5] Hegele RA, Ginsberg HN, Chapman MJ, et al.; European Atherosclerosis Society Consensus Panel. The polygenic nature of hypertriglyceridaemia: implications for definition, diagnosis, and management. Lancet Diabetes Endocrinol. 2014 Aug;2(8):655-66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4201123/ http://www.ncbi.nlm.nih.gov/pubmed/24731657?tool=bestpractice.com