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| {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org] | | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org] |
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| ==Overview== | | ==[[Hypertriglyceridemia overview|Overview]]== |
| '''Hypertriglyceridemia''' (or "Hypertriglyceridaemia") denotes high (''hyper-'') blood levels (''-emia'') of [[triglyceride]]s, the most abundant [[fat]]ty 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 test]]s; [[hyponatremia]] may be reported spuriously (''[[pseudohyponatremia]]'').
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| A related term is "Hyperglyceridemia" or "Hyperglyceridaemia", which refers to a high level of all [[glyceride]]s, including monoglycerides, diglycerides and triglycerides.
| | ==[[Hypertriglyceridemia historical perspective|Historical Perspective]]== |
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| ==Causes== | | ==[[Hypertriglyceridemia pathophysiology|Pathophysiology]]== |
| *[[Idiopathic]] (constitutional)
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| *[[Obesity]]
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| *High [[sugar]] diet
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| *[[Diabetes mellitus]] and [[insulin resistance]]
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| *Excess [[alcohol]] intake
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| *[[Metabolic syndrome]]
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| *[[Nephrotic syndrome]]
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| * Genetic predisposition
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| ==Treatment== | | ==[[Hypertriglyceridemia epidemiology and demographics|Epidemiology & Demographics]]== |
| Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the [[diet (nutrition)|diet]], as well as with [[niacin]], [[fibrate]]s and [[statin]]s (three classes of drugs). Increased [[fish oil]] intake may substantially lower an individual's triglycerides.<ref>{{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 | format= |work=}}</ref><ref name="pmid2035283">{{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=}}</ref><ref>{{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 |format= |work=}}</ref>
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| [[Clinical practice guidelines]] by the [[National Cholesterol Education Program]] (NCEP) suggests that pharmacotherapy be considered with triglycerides are over 200 mg/dl.<ref name="pmid11368702">{{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}}</ref> 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."<ref name="pmid11368702"/> | | ==[[Hypertriglyceridemia risk factors|Risk Factors]]== |
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| ===Primary prevention=== | | ==[[Hypertriglyceridemia screening|Screening]]== |
| 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).<ref name="pmid3313041">{{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=}}</ref>
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| ===Secondary prevention=== | | ==[[Hypertriglyceridemia causes|Causes of Hypertriglyceridemia]]== |
| 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).<ref name="pmid10438259">{{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=}}</ref>
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| | ==[[Hypertriglyceridemia differential diagnosis|Differentiating Hypertriglyceridemia from other Diseases]]== |
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| | ==[[Hypertriglyceridemia natural history|Natural History, Complications & Prognosis]]== |
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| | Diagnosis |
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| | ==[[Hypertriglyceridemia history and symptoms|History & Symptoms]]== |
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| | ==[[Hypertriglyceridemia physical examination|Physical Examination]]== |
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| | ==[[Hypertriglyceridemia laboratory tests|Lab Tests]]== |
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| | ==[[Hypertriglyceridemia electrocardiogram|Electrocardiogram]]== |
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| | ==[[Hypertriglyceridemia chest x ray|Chest X Ray]]== |
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| | ==[[Hypertriglyceridemia MRI|MRI]]== |
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| | ==[[Hypertriglyceridemia CT|CT]]== |
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| | ==[[Hypertriglyceridemia echocardiography or ultrasound|Echocardiography or Ultrasound]]== |
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| | ==[[Hypertriglyceridemia other imaging findings|Other Imaging Findings]]== |
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| | ==[[Hypertriglyceridemia other diagnostic studies|Other Diagnostic Studies]]== |
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| | Treatment |
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| | ==[[Hypertriglyceridemia medical therapy|Medical Therapy]]== |
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| | ==[[Hypertriglyceridemia surgery|Surgery]]== |
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| | ==[[Hypertriglyceridemia primary prevention|Primary Prevention]]== |
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| | ==[[Hypertriglyceridemia secondary prevention|Secondary Prevention]]== |
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| | ==[[Hypertriglyceridemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]== |
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| | ==[[Hypertriglyceridemia future or investigational therapies|Future or Investigational Therapies]]== |
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| ==References== | | ==References== |