Cardiovascular Medicine Book

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Hypertriglyceridemia

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  1. See Also
    1. Hyperlipidemia
  2. Pathophysiology
    1. Triglycerides are a major component of serum VLDL
    2. Independent risk factor for Coronary Artery Disease
      1. Triglycerides >500: Increases premature CAD risk by 11.4 fold
      2. Triglycerides >300 and HDL<30: Increases premature CAD risk by 17.2 fold
      3. Type III Dyslipidemia: Increases premature CAD risk by 5-10 fold
      4. (2005) JACC 45:1003
  3. Causes
    1. See Serum Triglycerides
  4. Management
    1. General therapeutic lifestyle changes
      1. Reduce body weight
      2. Increase aerobic Exercise
        1. Walking 3-4 miles in approximately 40 minutes daily normalizes Triglycerides within 1 week
        2. Oscai (1972) AJC 30:775
      3. Low Fat Diet
      4. Optimize blood sugar control in Diabetes Mellitus
      5. Consider Metabolic Syndrome management
    2. Serum Triglycerides 150 to 199 mg/dl (Borderline high)
      1. Therepeutic lifestyle changes above
      2. Lower LDL Cholesterol to goal (see Hyperlipidemia)
    3. Serum Triglycerides 200 to 499 (high)
      1. Therepeutic lifestyle changes above
      2. Primary goal: Lower LDL Cholesterol
        1. Statin AntiHyperlipidemics
      3. Secondary goal: Lower Triglycerides
        1. Niacin added to Statin
          1. May be best first-line combination therapy
          2. Less effect on Triglycerides than fibrate (consider adding fibrate)
        2. Fibrate added to Statin
          1. Tricor (risk of Myopathy when used with Statin)
          2. Gemfibrozil (higher risk of Myopathy than Tricor)
        3. Adjuncts: Fish oil 2-4 g EPA/DHA daily
    4. Serum Triglycerides >500 (very high)
      1. Therepeutic lifestyle changes above
      2. Primary goal is to lower Triglycerides
        1. First-line: Fibrate (Tricor, Gemfibrozil)
        2. Second-line: Niacin with or without Fibrate
        3. Adjuncts: Fish oil 2-4 g EPA/DHA daily
      3. Secondary goal is to lower LDL Cholesterol
        1. Consider adding a Statin to agents above
        2. Use caution due to Myopathy risk
    5. Serum Triglycerides >1000 (highest)
      1. Very Low Fat Diet (<15% of total calories)
      2. Aggressive weight loss
      3. High level of suspicion for secondary cause
      4. Management as fro Serum Triglycerides >500
  5. References
    1. (2001) JAMA 285:2486
    2. Oh (2007) Am Fam Physician 75:1365
    3. Safer (2002) Am Fam Physician 65:871

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