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Lipid Management in Endocrine Disorders

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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).

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