High triglyceride causes

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Lipoprotein Disorders Main Page

Hyperlipoproteinemia Microchapters

Hypercholesterolemia Patient Information

Hypertriglyceridemia Patient Information

Overview

Classification

Familial hyperchylomicronemia
Familial hypercholesterolemia
Familial combined hyperlipidemia
Dysbetalipoproteinemia
Primary hypertriglyceridemia
Mixed hyperlipoproteinemia

Differential Diagnosis

Screening

ACC/AHA Guideline Recommendations

Summary

Treatment

Major recommendations for statin therapy

Therapeutic response to statin therapy

Blood cholesterol LDL and non-HDL treatment goals

Treatment in heart failure and hemodialysis

Primary prevention

Secondary prevention

Intensity of statin therapy in primary and secondary prevention

Safety Recommendations

Guideline on Lifestyle Management

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]; Ogheneochuko Ajari, MB.BS, MS [3]

Overview

Hypertriglyceridemia can occur due to various causes, including genetics, familial, metabolic and drugs.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Hypertriglyceridemia does not have life threatening causes.

Common Causes

Causes by Organ System

Cardiovascular Alström syndrome, apoprotein E deficiency, chylomicron levels raised (plasma), familial chylomicronemia, familial combined hyperlipidemia, familial hypertriglyceridemia, hyperlipoproteinemia, familial type 5, intermediate density lipoprotein levels raised (plasma or serum), metabolic syndrome, Reaven syndrome X
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Systemic lupus erythematosus
Drug Side Effect Abiraterone, Amprenavir, atazanavir sulfate, atypical antipsychotics, bendrofluazide, beta-blockers, bexarotene, chlorthalidone, clomiphene, colesevelam hydrochloride, colestyramine, combined oral contraceptive pill, desvenlafaxine, diuretics, Drospirenone and Ethinyl estradiol, Efavirenz, estrogen replacement therapy, febuxostat, fosamprenavir, glucocorticoids, hydrochlorothiazide, interferon alpha, Interferon alfa-2b , Indinavir, Interferon gamma, linagliptin, lopinavir, Medroxyprogesterone, mirtazapine, non-nucleoside reverse transcriptase inhibitors, Norethindrone acetate and Ethinyl estradiol, Norgestimate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, olanzapine, oral isotretinoin, Pegaspargase, Pegylated interferon alfa-2b, propofol, protease inhibitors, raloxifene, ritonavir, Ruxolitinib,saquinavir, Siltuximab, tamoxifen, tazarotene, temsirolimus, tipranavir, tocilizumab, Tretinoin
Ear Nose Throat No underlying causes
Endocrine Cushing's syndrome, diabetes mellitus, hypothyroidism, insulin resistance, metabolic syndrome, polycystic ovary syndrome, Reaven syndrome X
Environmental No underlying causes
Gastroenterologic Acute pancreatitis, Alagille syndrome, carnitine palmitoyltransferase 1 deficiency, cholesteryl ester storage disease, glycogen storage disease type 1, glycogenosis type 1a, liver cirrhosis, non-alcoholic fatty liver disease
Genetic Alagille syndrome, Alström syndrome, apoprotein E deficiency, carnitine palmitoyltransferase 1 deficiency, cholesteryl ester storage disease, congenital generalized lipodystrophy type 1, deficiency of apolipoprotein C2 , familial chylomicronemia, familial combined hyperlipidemia, familial histiocytic reticulosis, familial hypertriglyceridemia, fish eye disease, glycogen storage disease type 1, glycogenosis type 1a, hyperlipoproteinemia, familial type 5, lecithin cholesterol acyltransferase deficiency, metabolic syndrome, Niemann-Pick disease type B, Reaven syndrome X, sphingomyelinase deficiency, Tangier disease
Hematologic Familial histiocytic reticulosis
Iatrogenic Parenteral nutrition
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic Systemic lupus erythematosus
Neurologic Niemann-Pick disease type B, sphingomyelinase deficiency
Nutritional/Metabolic Alcohol, apoprotein E deficiency, chylomicron levels raised (plasma), deficiency of apolipoprotein C2, familial chylomicronemia, familial combined hyperlipidemia, familial hypertriglyceridemia, glycogen storage disease type 1, glycogenosis type 1a, high carbohydrate or high glycemic index, hyperlipoproteinemia, familial type 5, intermediate density lipoprotein levels raised (plasma or serum), lipodystrophy, lipoprotein lipase deficiency, metabolic syndrome, obesity, Reaven syndrome X, Tangier disease, very low density lipoprotein levels raised (plasma or serum), vitamin E deficiency, familial isolated
Obstetric/Gynecologic Polycystic ovary syndrome, pregnancy
Oncologic No underlying causes
Ophthalmologic Diabetes mellitus, Lecithin cholesterol acyltransferase deficiency
Overdose/Toxicity Alcohol
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Chronic kidney disease, chronic renal insufficiency, diabetes mellitus, nephrotic syndrome, systemic lupus erythematosus
Rheumatology/Immunology/Allergy Macrophage activation syndrome, metabolic syndrome, paraproteinemias, Reaven syndrome X, systemic lupus erythematosus
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Alcohol

Causes in Alphabetical Order

Diagnosis

2018 AHA ACC Guideline on the Management of Blood Cholesterol. Hypertriglyceridemia Recommendations

Class I
"1. In adults 20 years of age or older with moderate hypertriglyceridemia (fasting or nonfasting triglycerides 175 to 499 mg/dL [2.0 to 5.6 mmol/L]), clinicians should address and treat lifestyle factors (obesity and metabolic syndrome), secondary factors (diabetes mellitus, chronic liver or kidney disease and/or nephrotic syndrome, hypothyroidism), and medications that increase triglycerides(Level of Evidence: B-NR) "

[3]

Class IIa
" 2. In adults 40 to 75 years of age with moderate or severe hypertriglyceridemia and ASCVD risk of 7.5% or higher, it is reasonable to reevaluate ASCVD risk after lifestyle and secondary factors are addressed and to consider a persistently elevated triglyceride level as a factor favoring initiation or intensification of statin therapy (Level of Evidence B-R)".
'' 3. In adults 40 to 75 years of age with severe hypertriglyceridemia (fasting triglycerides ≥500 mg/dL [≥5.6 mmol/L]) and ASCVD risk of 7.5% or higher, it is reasonable to address reversible causes of high triglyceride and to initiate statin therapy (Level of Evidence B-R)''
''4. In adults with severe hypertriglyceridemia (fasting triglycerides ≥500 mg/dL [≥5.7 mmol/L]), and especially fasting triglycerides ≥1000 mg/dL (11.3 mmol/L)), it is reasonable to identify and address other causes of hypertriglyceridemia), and if triglycerides are persistently elevated or increasing, to further reduce triglycerides by the implementation of a very low-fat diet, avoidance of refined carbohydrates and alcohol, consumption of omega-3 fatty acids, and, if necessary to prevent acute pancreatitis, fibrate therapy (Level of Evidence B- NR)''

[3]



References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Kolovou GD, Anagnostopoulou KK, Kostakou PM, Bilianou H, Mikhailidis DP (2009). "Primary and secondary hypertriglyceridaemia". Curr Drug Targets. 10 (4): 336–43. PMID 19355858.
  2. Fallat RW, Glueck CJ (1976). "Familial and acquired type V hyperlipoproteinemia". Atherosclerosis. 23 (1): 41–62. PMID 1078394.
  3. 3.0 3.1 Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS; et al. (2019). "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol. 73 (24): 3168–3209. doi:10.1016/j.jacc.2018.11.002. PMID 30423391.

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