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.
