Hypertriglyceridemia
8
2. Hypertriglyceridemia
➤ 2.1 In adults with fasting TG levels over 500 mg/dL (5.6 mmol/L), we
recommend pharmacologic treatment as adjunct to diet and exercise to
prevent pancreatitis. (1|⊕
)
Technical Remark:
▶ Patients with TG levels over 1000 mg/dL (11.3 mmol/L) often do not get an
adequate response to medications and therefore, control of diabetes, modification of
diet, and weight loss are essential.
➤ 2.2 In patients with TG-induced pancreatitis, we suggest against the use of
acute plasmapheresis as first-line therapy to reduce TG levels. (2|⊕
)
Technical Remark:
▶ Plasmapheresis may be useful in those who do not respond to conventional methods
of lowering TG such as individuals who have extraordinarily elevated TG levels (e.g.,
over 10,000 mg/dL [112.9 mmol/L]) or in extremely high-risk situations such as
pregnancy.
➤ 2.3 In patients without diabetes who have TG-induced pancreatitis, we
suggest against the routine use of insulin infusion. (2|⊕
)
Technical Remark:
▶ When uncontrolled diabetes is present, insulin therapy should be used to normalize
glucose levels.
➤ 2.4 In adults who are on statins and still have moderately elevated TG
levels >150 mg/dL (1.7 mmol/L), and who have either ASCVD or diabetes
plus two additional risk factors, we suggest adding eicosapentaenoic acid
(EPA) ethyl ester to reduce the risk of CVD. (2|⊕⊕⊕
)
Technical Remarks:
▶ Risk factors include traditional risk factors and risk-enhancing factors.
▶ The dose of EPA ethyl ester is 4 gms/day.
▶ If EPA ethyl ester is not available or accessible, then it is reasonable to consider a
fibrate.
➤ 2.5 In patients with elevated TG (>150 mg/dL to 499 mg/dL [1.7 mmol/L
to 5.6 mmol/L]), we suggest checking TG before and after starting a bile
acid sequestrant. (2|⊕
)
Technical Remark:
▶ Bile acid sequestrants are contraindicated when TG are above 500 mg/dL
(5.6 mmol/L).
