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24 Diagnosis 4.5.2. Hypertriglyceridemia COR LOE Recommendations I B-NR 1. In adults 20 years of age or older with moderate hypertriglyceridemia (fasting or non-fasting triglycerides 175-499 mg/dL [1.9-5.6 mmol/L]), clinicians should address and treat lifestyle factors (obesity and metabolic syndrome), secondary factors (diabetes mellitus, chronic liver or kidney disease and/or nephrotic syndrome, hypothyroidism), and medications that increase triglycerides. IIa B-R 2. In adults 40 to 75 years of age with moderate or severe hypertriglyceridemia and ASCVD risk of 7.5% or higher, it is reasonable to reevaluate ASCVD risk after lifestyle and secondary factors are addressed and to consider a persistently elevated triglyceride level as a factor favoring initiation or intensification of statin therapy (see Section 2.4.1.). IIa B-R 3. In adults 40 to 75 years of age with severe hypertriglyceridemia (fasting triglycerides ≥500 mg/dL [≥5.6 mmol/L]) and ASCVD risk of 7.5% or higher, it is reasonable to address reversible causes of high triglyceride and to initiate statin therapy. IIa B-NR 4. In adults with severe hypertriglyceridemia (fasting triglycerides ≥500 mg/dL [≥5.7 mmol/L], and especially fasting triglycerides ≥1000 mg/dL [11.3 mmol/L]), it is reasonable to identify and address other causes of hypertriglyceridemia, and if tri-glycerides are persistently elevated or increasing, to further reduce triglycerides by implementation of a very low-fat diet, avoidance of refined carbohydrates and alcohol, consumption of omega-3 fatty acids, and, if necessary to prevent acute pancreatitis, fibrate therapy. 4.5.3. Issues Specific to Women COR LOE Recommendations I B-NR 1. Clinicians should consider conditions specific to women, such as premature menopause (age <40 years) and history of pregnancy-associated disorders (hypertension, preeclampsia, gestational diabetes mellitus, small-for-gestational-age infants, preterm deliveries), when discussing lifestyle intervention and the potential for benefit of statin therapy. I C-LD 2. Women of childbearing age who are treated with statin therapy and are sexually active should be counseled to use a reliable form of contraception. I C-LD 3. Women of childbearing age with hypercholesterolemia who plan to become pregnant should stop the statin 1 to 2 months before pregnancy is attempted or, if they become pregnant while on a statin, should have the statin stopped as soon as the pregnancy is discovered.

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