High triglyceride causes

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Hypercholesterolemia Patient Information
Hypertriglyceridemia Patient Information
Overview
Classification Familial hyperchylomicronemia Familial hypercholesterolemia Familial combined hyperlipidemia Dysbetalipoproteinemia Primary hypertriglyceridemia Mixed hyperlipoproteinemia
Differential Diagnosis
Screening
ACC/AHA Guideline Recommendations
Summary
Treatment
Major recommendations for statin therapy
Therapeutic response to statin therapy
Blood cholesterol LDL and non-HDL treatment goals
Treatment in heart failure and hemodialysis
Primary prevention
Secondary prevention
Intensity of statin therapy in primary and secondary prevention
Safety Recommendations
Guideline on Lifestyle Management

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]; Ogheneochuko Ajari, MB.BS, MS [3]; Jair Basantes de la Calle, M.D.

Overview

Hypertriglyceridemia can occur due to various causes, including genetics, familial, metabolic and drugs.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Hypertriglyceridemia does not have life threatening causes.

Common Causes

• Diabetes mellitus
• Obesity

Causes by Organ System

Cardiovascular	Alström syndrome, apoprotein E deficiency, chylomicron levels raised (plasma), familial chylomicronemia, familial combined hyperlipidemia, familial hypertriglyceridemia, hyperlipoproteinemia, familial type 5, intermediate density lipoprotein levels raised (plasma or serum), metabolic syndrome, Reaven syndrome X
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Systemic lupus erythematosus
Drug Side Effect	Abiraterone, Amprenavir, atazanavir sulfate, atypical antipsychotics, bendrofluazide, beta-blockers, bexarotene, chlorthalidone, clomiphene, colesevelam hydrochloride, colestyramine, combined oral contraceptive pill, desvenlafaxine, diuretics, Drospirenone and Ethinyl estradiol, Efavirenz, estrogen replacement therapy, febuxostat, fosamprenavir, glucocorticoids, hydrochlorothiazide, interferon alpha, Interferon alfa-2b , Indinavir, Interferon gamma, linagliptin, lopinavir, Medroxyprogesterone, mirtazapine, non-nucleoside reverse transcriptase inhibitors, Norethindrone acetate and Ethinyl estradiol, Norgestimate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, olanzapine, oral isotretinoin, Pegaspargase, Pegylated interferon alfa-2b, propofol, protease inhibitors, raloxifene, ritonavir, Ruxolitinib,saquinavir, Siltuximab, tamoxifen, tazarotene, temsirolimus, tipranavir, tocilizumab, Tretinoin
Ear Nose Throat	No underlying causes
Endocrine	Cushing's syndrome, diabetes mellitus, hypothyroidism, insulin resistance, metabolic syndrome, polycystic ovary syndrome, Reaven syndrome X
Environmental	No underlying causes
Gastroenterologic	Acute pancreatitis, Alagille syndrome, carnitine palmitoyltransferase 1 deficiency, cholesteryl ester storage disease, glycogen storage disease type 1, glycogenosis type 1a, liver cirrhosis, non-alcoholic fatty liver disease
Genetic	Alagille syndrome, Alström syndrome, apoprotein E deficiency, carnitine palmitoyltransferase 1 deficiency, cholesteryl ester storage disease, congenital generalized lipodystrophy type 1, deficiency of apolipoprotein C2 , familial chylomicronemia, familial combined hyperlipidemia, familial histiocytic reticulosis, familial hypertriglyceridemia, fish eye disease, glycogen storage disease type 1, glycogenosis type 1a, hyperlipoproteinemia, familial type 5, lecithin cholesterol acyltransferase deficiency, metabolic syndrome, Niemann-Pick disease type B, Reaven syndrome X, sphingomyelinase deficiency, Tangier disease
Hematologic	Familial histiocytic reticulosis
Iatrogenic	Parenteral nutrition
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	Systemic lupus erythematosus
Neurologic	Niemann-Pick disease type B, sphingomyelinase deficiency
Nutritional/Metabolic	Alcohol, apoprotein E deficiency, chylomicron levels raised (plasma), deficiency of apolipoprotein C2, familial chylomicronemia, familial combined hyperlipidemia, familial hypertriglyceridemia, glycogen storage disease type 1, glycogenosis type 1a, high carbohydrate or high glycemic index, hyperlipoproteinemia, familial type 5, intermediate density lipoprotein levels raised (plasma or serum), lipodystrophy, lipoprotein lipase deficiency, metabolic syndrome, obesity, Reaven syndrome X, Tangier disease, very low density lipoprotein levels raised (plasma or serum), vitamin E deficiency, familial isolated
Obstetric/Gynecologic	Polycystic ovary syndrome, pregnancy
Oncologic	No underlying causes
Ophthalmologic	Diabetes mellitus, Lecithin cholesterol acyltransferase deficiency
Overdose/Toxicity	Alcohol
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Chronic kidney disease, chronic renal insufficiency, diabetes mellitus, nephrotic syndrome, systemic lupus erythematosus
Rheumatology/Immunology/Allergy	Macrophage activation syndrome, metabolic syndrome, paraproteinemias, Reaven syndrome X, systemic lupus erythematosus
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Alcohol

Causes in Alphabetical Order

• Acute pancreatitis
• Alagille syndrome
• Alcohol
• Alström syndrome
• Amprenavir
• Apoprotein E deficiency
• Atazanavir sulfate
• Atypical antipsychotics
• Bendrofluazide
• Beta-blockers
• Bexarotene
• Carnitine palmitoyltransferase 1 deficiency
• Chlorthalidone
• Cholesteryl ester storage disease
• Chronic kidney disease
• Chronic renal insufficiency
• Chylomicron levels raised (plasma)
• Clomiphene
• Colesevelam hydrochloride
• Colestyramine
• Combined oral contraceptive pill
• Congenital generalized lipodystrophy type 1
• Cushing's syndrome
• Deficiency of apolipoprotein C2
• Desvenlafaxine
• Diabetes mellitus

• Diuretics
• Efavirenz
• Estrogen replacement therapy
• Familial chylomicronemia
• Familial combined hyperlipidemia
• Familial histiocytic reticulosis
• Familial hypertriglyceridemia
• Fish eye disease
• Fosamprenavir
• Glucocorticoids
• Glycogen storage disease type 1
• Glycogenosis type 1a
• High carbohydrate or high glycemic index
• Hydrochlorothiazide
• Hyperlipoproteinemia, familial type 5
• Hypothyroidism
• Indinavir
• Insulin resistance
• Interferon alpha
• Interferon gamma
• Intermediate density lipoprotein levels raised (plasma or serum)
• Lecithin cholesterol acyltransferase deficiency
• Linagliptin
• Lipodystrophy
• Lipoprotein lipase deficiency
• Liver cirrhosis
• Lopinavir
• Macrophage activation syndrome
• Medroxyprogesterone
• Metabolic syndrome

• Mirtazapine
• Nephrotic syndrome
• Niemann-Pick disease type B
• Non-alcoholic fatty liver disease
• Non-nucleoside reverse transcriptase inhibitors
• Norgestrel and Ethinyl estradiol
• Obesity
• Olanzapine
• Oral isotretinoin
• Paraproteinemias
• Parenteral nutrition
• Pegaspargase
• Polycystic ovary syndrome
• Pregnancy
• Propofol
• Protease inhibitors
• Reaven syndrome X
• Ritonavir
• Saquinavir
• Siltuximab
• Sphingomyelinase deficiency
• Systemic lupus erythematosus
• Tamoxifen
• Tangier disease
• Temsirolimus
• Tipranavir
• Tocilizumab
• Tretinoin
• Very low density lipoprotein levels raised (plasma or serum)
• Vitamin E deficiency, familial isolated

Diagnosis

2018 AHA ACC Guideline on the Management of Blood Cholesterol. Hypertriglyceridemia Recommendations

Class I

"1. In adults 20 years of age or older with moderate hypertriglyceridemia (fasting or nonfasting triglycerides 175 to 499 mg/dL [2.0 to 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(Level of Evidence: B-NR) "

Class IIa

" 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 (Level of Evidence 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 (Level of Evidence B-R)''

''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 triglycerides are persistently elevated or increasing, to further reduce triglycerides by the 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 (Level of Evidence B- NR)''