Hypertriglyceridemia
| Hypertriglyceridemia | |
|---|---|
 | |
| Triglyceride, which cause hypertriglyceridemia at high level | |
| Classification and external resources | |
| Specialty | endocrinology |
| ICD-10 | E78.1, E78.2, E78.3 |
| ICD-9-CM | 272.1 |
| OMIM | 145750 |
| DiseasesDB | 6372 |
| MedlinePlus | 000397 |
| eMedicine | med/2921 article/126568 |
| MeSH | D015228 |
Hypertriglyceridemia denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. Elevated levels of triglycerides are associated with atherosclerosis, even in the absence of hypercholesterolemia (high cholesterol levels), and predispose to cardiovascular disease. Very high triglyceride levels also increase the risk of acute pancreatitis. Hypertriglyceridemia itself is usually symptomless, although high levels may be associated with skin lesions known as xanthomas.[1]
The diagnosis is made on blood tests, often performed as part of screening. Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.[1]
Weight loss and dietary modification may improve hypertriglyceridemia. The decision to treat hypertriglyceridemia with medication depends on the levels and on the presence of other risk factors for cardiovascular disease. Very high levels that would increase the risk of pancreatitis is treated with a drug from the fibrate class. Niacin and omega-3 fatty acids as well as drugs from the statin class may be used in conjunction, with statins being the main drug treatment for moderate hypertriglyceridemia where reduction of cardiovascular risk is required.[1]
Signs and symptoms
Most people with elevated triglycerides experience no symptoms. Some forms of primary hypertriglyceridemia can lead to specific symptoms: both familial chylomicronemia and primary mixed hyperlipidemia include skin symptoms (eruptive xanthoma), eye abnormalities (lipemia retinalis), hepatosplenomegaly (enlargement of the liver and spleen), and neurological symptoms. Some experience attacks of abdominal pain that may be mild episodes of pancreatitis. Eruptive xanthomas are 2–5 mm papules, often with a red ring around them, that occur in clusters on the skin of the trunk, buttocks and extremities.[2] Familial dysbetalipoproteinemia causes larger, tuberous xanthomas; these are red or orange and occur on the elbows and knees. Palmar crease xanthomas may also occur.[1][2]
The diagnosis is made on blood tests, often performed as part of screening. Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.[1]
Acute pancreatitis occurs in people whose triglyceride levels are above 1000 mg/dl (11.3 mmol/l).[1][2][3] Hypertriglyceridemia is associated with 1–4% of all cases of pancreatitis. The symptoms are similar to pancreatitis secondary to other causes, although the presence of xanthomas or risk factors for hypertriglyceridemia may offer clues.[3]
Causes
- High carbohydrate diet[4][5][6]
- High fat diet[7]
- Idiopathic (constitutional)
- Obesity
- Diabetes mellitus and insulin resistance - it is one of the defined components of metabolic syndrome (along with central obesity, hypertension, and hyperglycemia)
- Excess alcohol consumption
- renal failure, Nephrotic syndrome
- Genetic predisposition; some forms of familial hyperlipidemia such as familial combined hyperlipidemia i.e. Type II hyperlipidemia
- Lipoprotein lipase deficiency - Deficiency of this water-soluble enzyme, that hydrolyzes triglycerides in lipoproteins, leads to elevated levels of triglycerides in the blood.
- Lysosomal acid lipase deficiency or Cholesteryl ester storage disease
- Certain medications e.g. isotretinoin, estrogen, hydrochlorothiazide diuretics, beta blockers, protease inhibitors
- Hypothyroidism (underactive thyroid)
- Systemic Lupus Erythematosus
- Glycogen storage disease type 1.
- Propofol
- HIV medications
Screening
In 2016 the United States Preventive Services Task Force concluded that testing the general population under the age of 40 without symptoms is of unclear benefit.[8][9]
Treatment
Weight loss and dietary modification may be effective in hypertriglyceridemia. The decision to treat hypertriglyceridemia with medication depends on the levels and on the presence of other risk factors for cardiovascular disease. Very high levels that would increase the risk of pancreatitis is treated with a drug from the fibrate class. Niacin and omega-3 fatty acids as well as drugs from the statin class may be used in conjunction, with statins being the main drug treatment for moderate hypertriglyceridemia where reduction of cardiovascular risk is required.[1]
For people with mildly or moderately high levels of triglycerides lifestyle changes are recommended.[1] This may include restriction of carbohydrates and fat in the diet. Medications are recommended in those with high levels of triglycerides, with fibrates being recommended first.[1]
References
- 1 2 3 4 5 6 7 8 9 Berglund L, Brunzell JD, Goldberg AC, et al. (September 2012). "Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline". J. Clin. Endocrinol. Metab. 97 (9): 2969–89. doi:10.1210/jc.2011-3213. PMC 3431581
. PMID 22962670. - 1 2 3 Yuan G, Al-Shali KZ, Hegele RA (April 2007). "Hypertriglyceridemia: its etiology, effects and treatment". CMAJ. 176 (8): 1113–20. doi:10.1503/cmaj.060963. PMC 1839776. PMID 17420495.
- 1 2 Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A (April 2009). "Hypertriglyceridemic pancreatitis: presentation and management". Am. J. Gastroenterol. 104 (4): 984–91. doi:10.1038/ajg.2009.27. PMID 19293788.
- ↑ Silva, ME; Pupo, AA; Ursich, MJ (1987). "Effects of a high-carbohydrate diet on blood glucose, insulin and triglyceride levels in normal and obese subjects and in obese subjects with impaired glucose tolerance.". Brazilian Journal of Medical and Biological Research. 20 (3-4): 339–50. PMID 3330460.
- ↑ McCarty, MF (2004). "An elevation of triglycerides reflecting decreased triglyceride clearance may not be pathogenic -- relevance to high-carbohydrate diets.". Medical Hypotheses. 63 (6): 1065–73. doi:10.1016/j.mehy.2002.11.002. PMID 15504577.
- ↑ Garg, A; Grundy, SM; Unger, RH (Oct 1992). "Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM.". Diabetes. 41 (10): 1278–85. doi:10.2337/diabetes.41.10.1278. PMID 1397701.
- ↑ Pejic RN, Lee DT (May–Jun 2006). "Hypertriglyceridemia". J Am Board Fam Med. 19 (3): 310–6. doi:10.3122/jabfm.19.3.310. PMID 16672684.
- ↑ "Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 9 August 2016. doi:10.7326/M16-0946.
- ↑ "Screening for Lipid Disorders in Children and Adolescents". JAMA. August 9, 2016. doi:10.1001/jama.2016.9852.