|Triglyceride, which cause hypertriglyceridemia at high level|
|Complications||Cardiovascular disease, pancreatitis|
|Risk factors||Obesity, diabetes, genetics, metabolic syndrome, alcohol|
|Diagnostic method||Triglycerides > 150 mg/dL (1.7 mmol/L)|
|Treatment||Not drinking alcohol, weight loss, avoiding simple carbohydrates, controlling blood sugar|
|Medication||Fibrates, omega-3 fatty acids, insulin|
Hypertriglyceridemia is high (hyper-) blood levels (-emia) of triglycerides. High triglycerides itself is usually symptomless, although high levels may be associated with skin lesions known as xanthomas. High levels of triglycerides may also increase the risk of cardiovascular disease and pancreatitis. Generally only severe disease results in pancreatitis. High triglycerides may occur alone or with other lipid disorders.
Most cases result from a combination of factors. Common risk factors include obesity, diabetes, genetics, and metabolic syndrome. Other risks include alcohol, hypothyroidism, kidney problems, lupus, and certain medications such as protease inhibitors and birth control pills. Diagnosis is based on fasting triglycerides of greater than than 150 mg/dL (1.7 mmol/L). Moderate disease is 150 to 1,000 mg/dL (1.7 to 11.4 mmol/L) while severe disease is greater than 1,000 mg/dL (>11.4 mmol/L).
Treatment includes not drinking alcohol, weight loss, avoiding simple carbohydrates, and controlling blood sugar. Medications are generally not required, though fibrates and omega-3 fatty acids may help. In those with pancreatitis due to high triglycerides treatment is with intravenous fluids, insulin, and potentially plasmapheresis. High blood triglycerides affects about 30% of people in the United States and is more common in males and older people. Very high levels affect about 2% of people.
Signs and symptoms
Most people with elevated triglycerides experience no symptoms. Some forms of primary hypertriglyceridemia can lead to specific symptoms: both familial chylomicronemia and primary mixed hyperlipidemia include skin symptoms (eruptive xanthoma), eye abnormalities (lipemia retinalis), hepatosplenomegaly (enlargement of the liver and spleen), and neurological symptoms. Some experience attacks of abdominal pain that may be mild episodes of pancreatitis. Eruptive xanthomas are 2–5 mm papules, often with a red ring around them, that occur in clusters on the skin of the trunk, buttocks and extremities. Familial dysbetalipoproteinemia causes larger, tuberous xanthomas; these are red or orange and occur on the elbows and knees. Palmar crease xanthomas may also occur.
The diagnosis is made on blood tests, often performed as part of screening. Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.
Acute pancreatitis may occur in people whose triglyceride levels are above 1000 mg/dL (11.3 mmol/L). Hypertriglyceridemia is associated with 1–4% of all cases of pancreatitis. The symptoms are similar to pancreatitis secondary to other causes, although the presence of xanthomas or risk factors for hypertriglyceridemia may offer clues.
- Diabetes mellitus and insulin resistance - it is one of the defined components of metabolic syndrome (along with central obesity, hypertension, and hyperglycemia)
- Excess alcohol consumption
- Kidney failure, nephrotic syndrome
- Genetic predisposition; some forms of familial hyperlipidemia such as familial combined hyperlipidemia i.e. Type II hyperlipidemia
- Lipoprotein lipase deficiency - Deficiency of this water-soluble enzyme, that hydrolyzes triglycerides in lipoproteins, leads to elevated levels of triglycerides in the blood.
- Lysosomal acid lipase deficiency or Cholesteryl ester storage disease
- Certain medications e.g. isotretinoin, hydrochlorothiazide diuretics, beta blockers, protease inhibitors
- Hypothyroidism (underactive thyroid)
- Lupus and associated autoimmune responses 
- Glycogen storage disease type 1.
- Certain HIV medications
The diagnosis is made on blood tests, often performed as part of screening. The normal triglyceride level is less than 150 mg/dL (1.7 mmol/L). Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.
Lifestyle changes including weight loss, exercise and dietary modification may improve hypertriglyceridemia. This may include restriction of carbohydrates (specifically fructose) and fat in the diet and the consumption of omega-3 fatty acids from algae, nuts, and seeds.
The decision to treat hypertriglyceridemia with medication depends on the levels and on the presence of other risk factors for cardiovascular disease. Very high levels that would increase the risk of pancreatitis is treated with a drug from the fibrate class. Niacin and omega-3 fatty acids as well as drugs from the statin class may be used in conjunction, with statins being the main drug treatment for moderate hypertriglyceridemia where reduction of cardiovascular risk is required. Medications are recommended in those with high levels of triglycerides that are not corrected with lifestyle modifications, with fibrates being recommended first. Epanova (omega-3-carboxylic acids) is another prescription drug used to treat very high levels of blood triglycerides.
In those with pancreatitis due to high triglycerides treatment is with intravenous fluids, insulin, and potentially plasmapheresis. Insulin can be used either as an injection under the skin or into a vein. Doses of 0.1 to 0.4 units per kg per hour by slow injection have been used. Heparin has also be used, not for its blood thinning effect, but for its effect on an enzyme that regulates triglycerides.
As of 2006, the prevalence of hypertriglyceridemia in the United States was 30%.
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