Hypertriglyceridemia
Hypertriglyceridemia is a fasting triglyceride level of 150 mg/dL or higher, usually asymptomatic and found on screening, that raises atherosclerotic cardiovascular risk and, at very high levels, causes acute pancreatitis. First-line treatment is lifestyle change, with a statin added for cardiovascular risk reduction and fenofibrate reserved for pancreatitis prevention when severe.
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What this article covers
- Overview
Definition: a fasting or nonfasting serum triglyceride concentration of 150 mg/dL or higher, graded as borderline high, high, or very high (severe).
- Epidemiology
Common finding: mild to moderate hypertriglyceridemia is frequent and usually secondary to obesity, insulin resistance, or alcohol rather than a primary genetic disorder.
- Risk factors
Obesity and insulin resistance: central adiposity drives hepatic VLDL-triglyceride overproduction and impairs LPL activity.
- Pathophysiology
Two carrier particles: chylomicrons transport dietary triglyceride from the intestine and VLDL transports hepatic triglyceride; both are cleared by LPL anchored on capillary endothelium.
- Clinical features
Asymptomatic majority: no symptoms or physical findings; discovered on a fasting lipid panel obtained for routine cardiovascular risk assessment.
- Differential diagnosis
Familial hypercholesterolemia: LDL cholesterol is markedly elevated with tendon xanthomas, but triglycerides are typically normal, unlike primary hypertriglyceridemia.
- Diagnosis
What establishes the diagnosis: a fasting serum triglyceride level of 150 mg/dL or higher on a lipid panel, staged as borderline high (150 to 199), high (200 to 499), or very high/severe (500 or…
- Management
First action: start lifestyle change in every patient, a very-low-fat diet that limits simple carbohydrate and alcohol, routine physical activity, and weight loss; triglycerides are highly…
- Complications
Acute pancreatitis: the most feared acute complication, risk rising at roughly 1000 mg/dL and markedly above 2000 mg/dL; it can be necrotizing and life-threatening.
- Prognosis
Mild to moderate disease: generally a good prognosis with lifestyle change and, when indicated, a statin; the main long-term risk is cardiovascular rather than pancreatic.
- Prevention
Screening: the U.S. Preventive Services Task Force recommends universal lipid screening in adults aged 40 to 75 years, which captures most hypertriglyceridemia at an asymptomatic stage.
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Dyslipidemia is an abnormal lipid profile, chiefly elevated LDL cholesterol, that drives atherosclerotic cardiovascular disease. Management is risk-based LDL lowering with statins as the foundation, adding ezetimibe and PCSK9 inhibitors to reach targets, alongside lifestyle change and evaluation for severe genetic forms and hypertriglyceridemia.
- Familial hypercholesterolemia
Familial hypercholesterolemia is an inherited defect of LDL clearance, most often an LDL-receptor mutation, that produces lifelong severe LDL cholesterol elevation and premature atherosclerotic cardiovascular disease. The clinical diagnosis rests on an LDL cholesterol of 190 mg/dL or higher plus a qualifying family history, and treatment is age-independent high-intensity statin therapy, escalated with ezetimibe and PCSK9-pathway agents.
- Atherosclerosis
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- Obesity
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- Type 2 diabetes mellitus
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- Acute pancreatitis
Acute pancreatitis is acinar-cell autodigestion and inflammation of the pancreas, most often from gallstones or alcohol, diagnosed by the revised Atlanta criteria and graded mild, moderately severe, or severe by organ failure. Management centers on early goal-directed lactated Ringer's resuscitation, analgesia, early enteral feeding, and timed ERCP for gallstone pancreatitis with cholangitis, reserving antibiotics for confirmed infected necrosis.