Hypertriglyceridemia

Obtain a fasting triglyceride value to classify marked elevations accurately when an initial nonfasting triglyceride level exceeds 400 mg/dL. In untreated adults with lower nonfasting values, fasting and nonfasting lipid profiles may both be used for baseline LDL-C documentation and ASCVD-risk estimation. ACCACCLipid Manager - Mobile and Web Apps

A fasting triglyceride concentration of 500 mg/dL or higher identifies patients at risk for hypertriglyceridemia-associated pancreatitis and warrants serial assessment of response to therapy. Concentrations above 1,000 mg/dL are associated with chylomicronemia; above 1,500 mg/dL, examine specifically for eruptive xanthomas and lipemia retinalis and ask about prior or current pancreatitis. ACC+1ACCACC Consensus on ASCVD Risk Reduction in HypertriglyceridemiaACCACC Consensus on ASCVD Risk Reduction in Hypertriglyceridemia: Key Points - American College of Cardiology

If abdominal pain raises concern for acute pancreatitis in a patient with marked hypertriglyceridemia, manage as acute pancreatitis and measure triglycerides early. Hypertriglyceridemia-induced acute pancreatitis has been reported at triglyceride concentrations as low as 880 mg/dL, accounts for approximately 1% to 9% of acute pancreatitis cases, and may recur. ScienceDirect+1ScienceDirectSecondary Causes of Hypertriglyceridemia are Prevalent Among Patients Presenting With Hypertriglyceridemia Induced Acute Pancreatitis - ScienceDirectPubMedSecondary Causes of Hypertriglyceridemia are Prevalent Among Patients Presenting With Hypertriglyceridemia Induced Acute Pancreatitis - PubMed

At the first fasting confirmation, obtain a medication, alcohol, dietary, metabolic, renal, thyroid, and pregnancy history. Common secondary contributors include diabetes, chronic kidney disease, metabolic syndrome or obesity, pregnancy, chronic inflammatory disease, alcohol use, saturated-fat intake, and high-glycemic-index foods. ACC+1ACCACC Consensus on ASCVD Risk Reduction in HypertriglyceridemiaACCACC Consensus on ASCVD Risk Reduction in Hypertriglyceridemia: Key Points - American College of Cardiology

Order fasting glucose or hemoglobin A1c to identify diabetes or inadequate glycemic control; measure serum creatinine for kidney disease; and obtain thyroid testing and liver tests when the history or phenotype suggests hypothyroidism or hepatic/metabolic disease. In patients with suspected familial hypertriglyceridemia, fasting glucose, hemoglobin A1c, liver function testing, and thyroid function testing help identify conditions that worsen the phenotype. Wolters Kluwer+1Wolters KluwerHypertriglyceridemia : The Nurse PractitionerPubMedFamilial Hypertriglyceridemia - StatPearls - NCBI Bookshelf

Reconcile all medications and replace or stop a contributing agent when clinically feasible. Agents associated with worsening triglycerides include beta-blockers, diuretics, bile-acid resins, corticosteroids, estrogens, HIV protease inhibitors, tamoxifen, cyclophosphamide, and immunosuppressive drugs; product labeling for omega-3-acid ethyl esters also specifically identifies beta-blockers, thiazides, and estrogens as potentially exacerbating agents. dailymed nlm nih+3dailymed nlm nihOfficial Label (Printer Friendly)dailymed nlm nihThese highlights do not include all the information needed to use OMEGA-3-ACID ETHYL ESTERS CAPSULES safely and effectively. See full prescribing information for OMEGA-3-ACID ETHYL ESTERS CAPSULES. Initial U.S. Approval: 2004ACCACC Consensus on ASCVD Risk Reduction in HypertriglyceridemiaACCACC Consensus on ASCVD Risk Reduction in Hypertriglyceridemia: Key Points - American College of Cardiology

Refer to a registered dietitian and specify the triglyceride phenotype on the referral. ACC guidance recommends at least 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous-intensity exercise and a 5% to 10% weight reduction when appropriate; these measures accompany, rather than replace, correction of secondary causes. ACC+1ACCACC Consensus on ASCVD Risk Reduction in HypertriglyceridemiaACCACC Consensus on ASCVD Risk Reduction in Hypertriglyceridemia: Key Points - American College of Cardiology

For severe hypertriglyceridemia, restrict total dietary fat to 20 to 30 g/day. This differs from the approach to moderate hypertriglyceridemia, for which the recommended pattern is low in saturated fat, provides 30% to 35% of calories from fat, emphasizes protein, and markedly restricts high-glycemic-index foods, particularly fructose and starches. ACC+1ACCACC Consensus on ASCVD Risk Reduction in HypertriglyceridemiaACCACC Consensus on ASCVD Risk Reduction in Hypertriglyceridemia: Key Points - American College of Cardiology

Alcohol should be limited in hypertriglyceridemia and eliminated when triglycerides are markedly elevated. Recheck fasting triglycerides after dietary, weight, alcohol, medication, and metabolic interventions to determine whether the patient remains in a pancreatitis-risk range or has an underlying persistent chylomicronemia phenotype. ACC+1ACCACC Consensus on ASCVD Risk Reduction in HypertriglyceridemiaACCACC Consensus on ASCVD Risk Reduction in Hypertriglyceridemia: Key Points - American College of Cardiology

Icosapent ethyl is dosed at 4 g/day with food, either as two 1-g capsules twice daily or four 0.5-g capsules twice daily. Before treatment, identify and manage other causes of hypertriglyceridemia and continue dietary and physical-activity interventions during therapy; capsules should be swallowed whole. dailymed nlm nihdailymed nlm nihThese highlights do not include all the information needed to use ICOSAPENT ETHYL CAPSULES safely and effectively. See full prescribing information for ICOSAPENT ETHYL CAPSULES. ICOSAPENT ETHYL capsules, for oral useInitial U.S. Approval: 2012

Omega-3-acid ethyl esters are also dosed at 4 g/day, either as a single 4-g dose or as two 2-g doses twice daily. Confirm that lipid values are consistently abnormal before initiating therapy, treat contributors such as diabetes and hypothyroidism, and discontinue or change triglyceride-raising medications when possible. dailymed nlm nih+1dailymed nlm nihOfficial Label (Printer Friendly)dailymed nlm nihThese highlights do not include all the information needed to use OMEGA-3-ACID ETHYL ESTERS CAPSULES safely and effectively. See full prescribing information for OMEGA-3-ACID ETHYL ESTERS CAPSULES. Initial U.S. Approval: 2004

Neither icosapent ethyl nor omega-3-acid ethyl esters has established efficacy for reducing pancreatitis risk in severe hypertriglyceridemia according to FDA labeling. Therefore, use a prescription omega-3 agent as part of a comprehensive triglyceride-lowering plan, not as a substitute for very-low-fat intake, alcohol elimination, or correction of uncontrolled diabetes and other precipitants. dailymed nlm nih+4dailymed nlm nihThese highlights do not include all the information needed to use ICOSAPENT ETHYL CAPSULES safely and effectively. See full prescribing information for ICOSAPENT ETHYL CAPSULES. ICOSAPENT ETHYL capsules, for oral useInitial U.S. Approval: 2012dailymed nlm nihOfficial Label (Printer Friendly)dailymed nlm nihThese highlights do not include all the information needed to use OMEGA-3-ACID ETHYL ESTERS CAPSULES safely and effectively. See full prescribing information for OMEGA-3-ACID ETHYL ESTERS CAPSULES. Initial U.S. Approval: 2004ACCACC Consensus on ASCVD Risk Reduction in HypertriglyceridemiaACCACC Consensus on ASCVD Risk Reduction in Hypertriglyceridemia: Key Points - American College of Cardiology

Mild and moderate hypertriglyceridemia may be a marker of ASCVD risk, whereas severe and very severe hypertriglyceridemia principally increase pancreatitis risk. Continue LDL-C–directed risk assessment and therapy rather than treating triglycerides as the sole lipid target. Oxford Academic+1Oxford AcademicAn Endocrine Society Clinical Practice GuidelineOxford AcademicEvaluation and Treatment of Hypertriglyceridemia: An Endocrine ...

Do not infer low long-term cardiovascular risk from a low LDL-C concentration in patients with extreme hypertriglyceridemia. In a cohort of patients with familial chylomicronemia syndrome and comparator patients with triglycerides above 750 mg/dL plus prior pancreatitis, cardiovascular events occurred in 50% by age 60 years despite most participants having LDL-C below 70 mg/dL. jaccjaccFamilial Chylomicronemia Syndrome: Clinical Characteristics and Long-Term Cardiovascular Outcomes | JACC

ApoB or LDL-C elevation favors familial combined hyperlipidemia over familial hypertriglyceridemia and changes the long-term emphasis toward treatment of the broader atherogenic lipoprotein burden. Conversely, persistent severe triglyceride elevation with relatively low LDL-C and recurrent pancreatitis should maintain focus on chylomicronemia prevention and genetic evaluation. jacc+1jaccFamilial Chylomicronemia Syndrome: Clinical Characteristics and Long-Term Cardiovascular Outcomes | JACCPubMedFamilial Hypertriglyceridemia - StatPearls - NCBI Bookshelf