Hypertriglyceridemia: the importance of identifying patients at risk

ABSTRACT

This review aims to explain risk factors, consequences, and management strategies recommended for patients with hypertriglyceridemia. A search of PubMed was performed: ‘Hypertriglyceridemia’[Majr], limited to English‐language and published in the 5 years up to April 2016. Abstracts of the 680 results were screened for inclusion. Reference lists of publications included were also screened for inclusion.

Approximately 25% of the United States population has elevated (≥150 mg/dL) triglycerides (TG) putting them at an increased risk of cardiovascular disease, non-alcoholic fatty liver disease, and pancreatitis. Risk factors for hypertriglyceridemia include genetics, lifestyle and diet, renal disease, endocrine disorders, and certain medications. Guidelines recommend that all patients with hypertriglyceridemia are advised on lifestyle modification to reduce TG to <150 mg/dL; a reduction in body weight of 5–10% can reduce TG by approximately 20%. For patients with TG <400 mg/dL, the primary goal is to reduce low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol, with most guidelines recommending statin therapy. When TG is ≥500 mg/dL the primary goal is to reduce TG levels to lower the risk of pancreatitis. Statin therapy (if LDL-C is elevated) in combination with a fibrate, or long-chain omega-3 fatty acid may be required. The Food and Drug Administration withdrew approval for niacin and some fibrates in combination with statins in April 2016 citing unfavorable benefit-risk profiles. With the increasing incidence of associated conditions (e.g. obesity, metabolic syndrome, and type 2 diabetes mellitus), it is likely that primary care physicians will encounter more patients with hypertriglyceridemia.

KEYWORDS:

• Coronary artery disease
• diabetes
• hypertriglyceridemia
• pancreatitis

Declaration of interest

Medical writing support was provided by Kerren Davenport (Prime Medica Ltd, Knutsford, Cheshire, UK) and funded by AstraZeneca. PA Kushner has been a consultant for Abbott, AstraZeneca, Lilly, and Janssen, and a speaker for AstraZeneca and Janssen. ME Cobble has received consulting fees, grants, or been on speaker boards for Amgen, AstraZeneca, Boehringer Ingelheim, Janssen, Kowa, and Sanofi Regeneron. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This article was funded by AstraZeneca.