High triglyceride natural history, prognosis and complications: Difference between revisions
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==Atherosclerosis and Cardiovascular Events== | __NOTOC__ | ||
It remains unclear if there is an independent association between hypertriglyceridemia and adverse cardiovascular outcomes <ref>Le NA, Walter MF. The role of hypertriglyceridemia in atherosclerosis. Curr Atheroscler Rep 2007; 9:110-5.</ref><ref>Stalenhoef AF, de Graaf J. Association of fasting and nonfasting serum triglycerides with cardiovascular disease and the role of remnant-like lipoproteins and small dense LDL. Curr Opin Lipidol 2008; 19:355-61.</ref> | {{Triglyceride}} | ||
{{CMG}} | |||
==Overview== | |||
==Unclear Association of Hypertriglyceridemia with Atherosclerosis and Cardiovascular Events== | |||
It remains unclear if there is an independent association between hypertriglyceridemia and adverse cardiovascular outcomes <ref>Le NA, Walter MF. The role of hypertriglyceridemia in atherosclerosis. Curr Atheroscler Rep 2007; 9:110-5.</ref><ref>Stalenhoef AF, de Graaf J. Association of fasting and nonfasting serum triglycerides with cardiovascular disease and the role of remnant-like lipoproteins and small dense LDL. Curr Opin Lipidol 2008; 19:355-61.</ref>. The ascertainment of any independent association between hypertriglyceridemia and clinical outcomes is confounded by the fact that hypertriglyceridemia is associated with so many atherosclerotic risk factors including obesity, diabetes and [[insulin resistance]], [[metabolic syndrome]], the presence of other dyslipidemias associated themselves both with high triglycerides and atherosclerosis (e.g. [[mixed hyperlipidemia]], low HDL ([[hypoalphalipoproteinemia]]), [[Familial dysbetalipoproteinemia]] ([[type III hyperlipoproteinemia]]), etc.), high levels of small, dense [[LDL]] and finally high levels of [[apolipoprotein B]] (apoB). | |||
For example, the relationship among hypertriglyceridemia, atherosclerosis, and apoB is complex. Specifically, those forms of hypertriglyceridemia associated with high levels of [[apoB]], but not those associated with low levels of apoB, are associated with atherosclerosis.<ref>Sniderman A, Couture P, de Graaf J. Diagnosis and treatment of apolipoprotein B dyslipoproteinemias. Nat Rev Endocrinol 2010; 6:335-46.</ref> | For example, the relationship among hypertriglyceridemia, atherosclerosis, and apoB is complex. Specifically, those forms of hypertriglyceridemia associated with high levels of [[apoB]], but not those associated with low levels of apoB, are associated with atherosclerosis.<ref>Sniderman A, Couture P, de Graaf J. Diagnosis and treatment of apolipoprotein B dyslipoproteinemias. Nat Rev Endocrinol 2010; 6:335-46.</ref> | ||
==Pancreatitis== | |||
Hypertriglyceridemia can be associated with [[pancreatitis]] when the triglyceride levels are markedly elevated (i.e. when the triglyceride concentration is greater, and often very much greater, than 1000 mg/dl or 12 mmol/l). | |||
==Acute Treatment of Pancreatitis Due to Hypertriglyceridemia== | |||
*The patient should be treated with [[apheresis]] (specifically [[therapeutic plasma exchange]]) if the following are present: | |||
:*[[Triglyceride]] level is > 1000 mg/dl | |||
:*[[Lipase]] level is > 3 times the upper limit of normal | |||
:*[[Lactic acidosis]] | |||
:*[[Hypocalcemia]] | |||
The patient should be treated with intravenous insulin at 0.1 to 0.3 units/kg/day to maintain glucose of 150 to 200 if the following are present: | |||
:*The patient cannot tolerate apheresis | |||
:*Apheresis is not available, | |||
:*Serum glucose >500 mg/dL | |||
*The insulin should be discontinued when the triglyceride level drops to below 500 mg/dl | |||
Secondary prevention of hypertriglyeride induced pancreatitis consists of a low-carbohydrate diet and gemfibrozil 600 mg PO BID. | |||
==Xanthoma== | |||
[[Image:xanthoma.jpg|left|thumb|Photograph of patient's hands showing multiple [[xanthoma tendinosum]]]] | |||
{{clr}} | |||
==References== | |||
{{Reflist|2}} | |||
{{Lipopedia}} | |||
{{WH}} | |||
{{WS}} | |||
[[Category:Lipopedia]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Cardiology]] | |||
Latest revision as of 20:20, 18 July 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Unclear Association of Hypertriglyceridemia with Atherosclerosis and Cardiovascular Events
It remains unclear if there is an independent association between hypertriglyceridemia and adverse cardiovascular outcomes [1][2]. The ascertainment of any independent association between hypertriglyceridemia and clinical outcomes is confounded by the fact that hypertriglyceridemia is associated with so many atherosclerotic risk factors including obesity, diabetes and insulin resistance, metabolic syndrome, the presence of other dyslipidemias associated themselves both with high triglycerides and atherosclerosis (e.g. mixed hyperlipidemia, low HDL (hypoalphalipoproteinemia), Familial dysbetalipoproteinemia (type III hyperlipoproteinemia), etc.), high levels of small, dense LDL and finally high levels of apolipoprotein B (apoB).
For example, the relationship among hypertriglyceridemia, atherosclerosis, and apoB is complex. Specifically, those forms of hypertriglyceridemia associated with high levels of apoB, but not those associated with low levels of apoB, are associated with atherosclerosis.[3]
Pancreatitis
Hypertriglyceridemia can be associated with pancreatitis when the triglyceride levels are markedly elevated (i.e. when the triglyceride concentration is greater, and often very much greater, than 1000 mg/dl or 12 mmol/l).
Acute Treatment of Pancreatitis Due to Hypertriglyceridemia
- The patient should be treated with apheresis (specifically therapeutic plasma exchange) if the following are present:
- Triglyceride level is > 1000 mg/dl
- Lipase level is > 3 times the upper limit of normal
- Lactic acidosis
- Hypocalcemia
The patient should be treated with intravenous insulin at 0.1 to 0.3 units/kg/day to maintain glucose of 150 to 200 if the following are present:
- The patient cannot tolerate apheresis
- Apheresis is not available,
- Serum glucose >500 mg/dL
- The insulin should be discontinued when the triglyceride level drops to below 500 mg/dl
Secondary prevention of hypertriglyeride induced pancreatitis consists of a low-carbohydrate diet and gemfibrozil 600 mg PO BID.
Xanthoma
References
- ↑ Le NA, Walter MF. The role of hypertriglyceridemia in atherosclerosis. Curr Atheroscler Rep 2007; 9:110-5.
- ↑ Stalenhoef AF, de Graaf J. Association of fasting and nonfasting serum triglycerides with cardiovascular disease and the role of remnant-like lipoproteins and small dense LDL. Curr Opin Lipidol 2008; 19:355-61.
- ↑ Sniderman A, Couture P, de Graaf J. Diagnosis and treatment of apolipoprotein B dyslipoproteinemias. Nat Rev Endocrinol 2010; 6:335-46.