Hypertriglyceridemia

Infobox_Disease
Name = PAGENAME


Caption =
DiseasesDB = 6372
ICD10 = ICD10|E|78|1|e|70, ICD10|E|78|2|e|70, ICD10|E|78|3|e|70
ICD9 = ICD9|272.1
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = med
eMedicineTopic = 2921
MeshID = D015228
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.

igns 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 sugar 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
* Certain medications (e.g. isotretinoin)
* Hypothyroidism (underactive thyroid)

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. [cite web |url=http://www.lipidsonline.org/slides/slide01.cfm?q=hypertriglyceridemia&dpg=13 |title=Lipids Online Slides: hypertriglyceridemia, ICAM-1, fish oil, E-selectin |accessdate=2007-09-05 |format= |work=] cite journal |author=Terres W, Beil U, Reimann B, Tiede S, Bleifeld W |title= [Low-dose fish oil in primary hypertriglyceridemia. A randomized placebo-controlled study] |language=German |journal=Zeitschrift für Kardiologie |volume=80 |issue=1 |pages=20–4 |year=1991 |pmid=2035283 |doi=] [cite web |url=http://www.findarticles.com/p/articles/mi_m0887/is_n4_v9/ai_8960077 |title=Fish oils in hypertriglyceridemia - Fish Oils Revisited Nutrition Research Newsletter - Find Articles |accessdate=2007-09-05 |format= |work=]

Clinical practice guidelines by the National Cholesterol Education Program (NCEP) suggests that pharmacotherapy be considered with a triglycerides level over 200 mg/dl.cite journal |author= |title=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) |journal=JAMA |volume=285 |issue=19 |pages=2486–97 |year=2001 |pmid=11368702 |doi=|url=http://jama.ama-assn.org/cgi/content/full/285/19/2486] 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 ( [http://jama.ama-assn.org/cgi/content/full/285/19/2486/TABLEJSC10094T9 Table 9] ) on the premise that a VLDL cholesterol level 30 mg/dL is normal."

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).cite journal |author=Frick MH, Elo O, Haapa K, "et al" |title=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 |journal=N. Engl. J. Med. |volume=317 |issue=20 |pages=1237–45 |year=1987 |pmid=3313041 |doi=]

econdary 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).cite journal |author=Rubins HB, Robins SJ, Collins D, "et al" |title=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 |journal=N. Engl. J. Med. |volume=341 |issue=6 |pages=410–8 |year=1999 |pmid=10438259|doi=10.1056/NEJM199908053410604]

References