Hypertriglyceridemia

Brief Overview: Elevated triglyceride levels >150mg/dL

Prevalence: Estimated to be ~30% among adults in the US

Etiology: Typically, genetics and secondary conditions contribute to the development of hypertriglyceridemia. Genetic cause is considered primary. Some secondary/acquired causes include insulin resistance, diabetes, obesity, renal disease, alcohol consumption, multiple myeloma, SLE, and certain medications.

Risk Factors:

• Diet
• Stress
• Physical inactivity
• Smoking

Commonly Associated Conditions:

• Pancreatitis
• Atherosclerotic cardiovascular disease (ASCVD)
• Insulin resistance
• Fatty liver disease
• Obesity

Common Medications:

• Statins – rosuvastatin, atorvastatin, pravastatin
• Fibrates – fenofibrate
• Marine omega-3 fatty acids – icosapent ethyl (Vascepa), Lovaza
• APOC3 inhibitors (Olezarsen) – for patients with familial chylomicronemia syndrome

Common Labs, Imaging, and Tests:

• Fasting lipid panel
• Serum blood glucose, HgbA1c, creatinine, TSH, CMP, urinalysis

Common Symptoms:

• Typically, asymptomatic
• Xanthomas – yellowish, raised bumps on the skin

Common Treatments:

• Medication (see above)
• Lifestyle modification – diet modification, exercise
• Treatment/management of any comorbidities
• Smoking cessation
• Weight Loss
• Reduced alcohol consumption/alcohol avoidance

Physical Findings:

• Typically, no physical findings
• Possible xanthomas
• Obesity, elevated BMI

Potential Complications and Contraindications:

• Increased risk of heart attack and stroke
• Acute pancreatitis
• Avoid fibrates in some patients/close monitoring of fibrates needed with some patients

General Health and Lifestyle Guidance:

• Smoking cessation
• Decreased alcohol consumption/avoidance of alcohol for some
• Work with your healthcare provider and/or dietician to determine which dietary modifications are appropriate for you
• Decrease added sugars, refined carbohydrates, and saturated fats
• Ask your healthcare provider what exercises are safe and appropriate for you
• Maintain a healthy weight

Suggested Questions to Ask Patients:

• Have you had your triglycerides or cholesterol checked recently?
• What does your typical diet look like?
• Do you have a history of diabetes or high blood sugar?
• Do you drink alcohol regularly?
• Have you ever had pancreatitis or unexplained abdominal pain?

Suggested Talking Points:

• Follow your treatment plan as prescribed
• Follow up with your healthcare provider as directed for repeat lab testing and ongoing management
• Lifestyle modifications can have a significant impact on lowering your triglycerides level

Sources:

• UpToDate
• Mount Sinai
• Cleveland Clinic
• Medscape