Hypertriglyceridemia
| Hypertriglyceridemia | |
|---|---|
| Classification and external resources | |
| ICD-10 | E78.1, E78.2, E78.3 |
| ICD-9 | 272.1 |
| DiseasesDB | 6372 |
| eMedicine | med/2921 |
| MeSH | D015228 |
In medicine, hypertriglyceridemia 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" which refers to a high level of all glycerides, including monoglycerides, diglycerides and triglycerides.
Contents
Signs and symptoms
Modestly elevated triglyceride levels do not lead to any physical symptoms. Higher levels are associated with lipemia retinalis (white appearance of the retina), eruptive xanthomas (small lumps in the skin, sometimes itchy).
Causes
- Idiopathic (constitutional)
- Obesity
- High carbohydrate diet
- Diabetes mellitus and insulin resistance - it is one of the defined components of metabolic syndrome (along with central obesity, hypertension, and hyperglycemia)
- Excess alcohol intake
- Nephrotic syndrome
- Genetic predisposition
- Some forms of familial hyperlipidemia, such as familial combined hyperlipidemia
- Certain medications (e.g., isotretinoin), estogen, hydrochlorothiazide diuretics, beta blockers, protease inhibitors.
- Hypothyroidism (underactive thyroid)
- Systemic Lupus Erythematosus
- Glycogen storage disease type 1.
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) suggest that pharmacotherapy should be considered for a triglycerides level 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]
Non–HDL cholesterol contains the highly atherogenic, small, dense lipoproteins that are associated with a high incidence of cardiovascular disease (CVD). Studies subsequent to the NCEP report have shown that the non–HDL cholesterol level predicts CVD in people who have diabetes. It may be superior to LDL cholesterol in this regard, and should be used as the primary lipid target in persons with diabetes. [5]
Primary prevention
Omega-3 fatty acid supplementation in the form of fish oil has been found to be effective in decreasing levels of triglycerides and thus all cardiovascular events by 19% to 45%.[6]
Gemfibrozil twice daily in asymptomatic men ages 40–55 without heart disease was also found to be effective at reducing cardiac endpoints at 5 years (4.14% to 2.73%). This means that 54 people must take the treatment for five years to prevent one cardiac event (number needed to treat of 54).[7]
Secondary prevention
A randomized controlled trial of men with known heart disease and HDL cholesterol of 40 mg/dl or less , 600 mg of gemfibrozil twice daily reduced cardiac endpoints (non-fatal 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).[8]
References
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sl:Hipertrigliceridemija- ↑ "Lipids Online Slides: hypertriglyceridemia, ICAM-1, fish oil, E-selectin". Retrieved 2007-09-05.
- ↑ Terres W, Beil U, Reimann B, Tiede S, Bleifeld W (1991). "[Low-dose fish oil in primary hypertriglyceridemia. A randomized placebo-controlled study]". Zeitschrift für Kardiologie (in German). 80 (1): 20–4. PMID 2035283.
- ↑ "Fish oils in hypertriglyceridemia - Fish Oils Revisited Nutrition Research Newsletter - Find Articles". Retrieved 2007-09-05.
- ↑ 4.0 4.1 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (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. doi:10.1001/jama.285.19.2486. PMID 11368702.
- ↑ Shahady EJ (September 1, 2008). "Non-HDL Cholesterol: When—and How—to Treat". Consultant. 48 (10).
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ 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. doi:10.1056/NEJM198711123172001. PMID 3313041.
- ↑ 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. doi:10.1056/NEJM199908053410604. PMID 10438259.
