Hypertriglyceridemia

In medicine, hypertriglyceridemia (or "Hypertriglyceridaemia") denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. It has been associated with atherosclerosis, even in the absence of hypercholesterolemia (high cholesterol levels). It can also lead to pancreatitis in excessive concentrations. Very high triglyceride levels may also interfere with blood tests; hyponatremia may be reported spuriously (pseudohyponatremia).

A related term is "Hyperglyceridemia" or "Hyperglyceridaemia", which refers to a high level of all glycerides, including monoglycerides, diglycerides and triglycerides.

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Causes include

• Idiopathic (constitutional)
• Obesity
• High sugar diet
• Diabetes mellitus and insulin resistance
• Excess alcohol intake
• Nephrotic syndrome
• Genetic predisposition
• Certain medications (e.g. isotretinoin)

Treatment

Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the diet, as well as with niacin, fibrates and statins (three classes of drugs). Increased fish oil intake may substantially lower an individual's triglycerides.^[1][2][3]

Clinical practice guidelines by the National Cholesterol Education Program (NCEP) suggests that pharmacotherapy be considered with triglycerides are over 200 mg/dl.^[4] The guidelines state "the sum of LDL + VLDL cholesterol (termed non-HDL cholesterol [total cholesterol - HDL cholesterol]) as a secondary target of therapy in persons with high triglycerides (200 mg/dL). The goal for non-HDL cholesterol in persons with high serum triglycerides can be set at 30 mg/dL higher than that for LDL cholesterol (Table 9) on the premise that a VLDL cholesterol level 30 mg/dL is normal."^[4]

Primary prevention

In the Helsinki Heart Study, a randomized controlled trial of asymptomatic men ages 40-55 without heart disease, 600 mg of gemfibrozil twice daily reduced cardiac endpoints at 5 years from 4.14% to 2.73%. This means that 54 patients must be treated for five years to prevent one cardiac event (number needed to treat is 54).^[5]

Secondary prevention

In the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study (VA-HIT), a randomized controlled trial of men with known heart disease HDL cholesterol of 40 mg/dl or less , 600 mg of gemfibrozil twice daily reduced cardiac endpoints ( nonfatal myocardial infarction or death from coronary causes) at 5 years from 21.7% to 17.3%. This means that 23 patients must be treated for five years to prevent one cardiac event (number needed to treat is 23).^[6]

References

1. ^ Lipids Online Slides: hypertriglyceridemia, ICAM-1, fish oil, E-selectin. Retrieved on 2007-09-05.
2. ^ Terres W, Beil U, Reimann B, Tiede S, Bleifeld W (1991). "[Low-dose fish oil in primary hypertriglyceridemia. A randomized placebo-controlled study]" (in German). Zeitschrift für Kardiologie 80 (1): 20-4. PMID 2035283.
3. ^ Fish oils in hypertriglyceridemia - Fish Oils Revisited Nutrition Research Newsletter - Find Articles. Retrieved on 2007-09-05.
4. ^ ^{a b} (2001) "Executive Summary of The 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)". JAMA 285 (19): 2486-97. PMID 11368702.
5. ^ Frick MH, Elo O, Haapa K, et al (1987). "Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease". N. Engl. J. Med. 317 (20): 1237-45. PMID 3313041.
6. ^ Rubins HB, Robins SJ, Collins D, et al (1999). "Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group". N. Engl. J. Med. 341 (6): 410-8. PMID 10438259.