12
Hypertriglyceridemia
Table 4. Evaluation of Hypertriglyceridemia
Medical history
• Personal and family history of high TG, diabetes, pancreatitis, thyroid issues
• Medicinal history: prescription, supplements
▶ Anti-psychotics, alpha-interferon, beta-blockers, bile acid sequestrants, hormones,
protease inhibitors, retinoids, thiazides, steroids
Lifestyle issues
• Alcohol use
• Smoking
• Activity status
Laboratory testing
• Renal function including urine protein
• Thyroid function
• Liver enzymes
• Fasting glucose, glycated hemoglobin (Hgb A1c)
Physical Examination
• BMI and waist size
• Blood pressure
• Skin examination (xanthomata, acanthosis nigricans)
Î Currently, TG is not a specific target for therapy except when levels
are ≥500 mg/dL.
Î When the TG concentration is ≥500 mg/dL, and especially if
≥1000 mg/dL, reducing risk of pancreatitis by lowering of TG to
<500 mg/dL becomes the primary goal of therapy.
Î Presently, prescription EPA and EPA + DHA concentrates, which have
been approved in ethyl ester and carboxylic acid forms, are indicated
for the treatment of very high TG (≥500 mg/dL).
Î Fibrate drugs can reduce TG and non-HDL-C in patients with mixed
dyslipidemia, and are considered a first-line choice for patients with
severe hypertriglyceridemia (TG ≥500 mg/dL).
Algorithm Footnotes
a
Adapted from Miller M, et al. Circulation. 2011;123:2292-2333.
b
Special consideration for patients with initial TG ≥1000 mg/dL and chylomicronemia: recheck lipids in 2
weeks. When TG <500 mg/dL, diet may gradually be liberalized with monitoring.
c
In addition to added sugars, some foods and beverages that are high in naturally occurring sugars, e.g.,
honey and fruit juices, should be limited.
