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Hypertriglyceridemia: its etiology, effects and treatment
Open accessAbstract
Elevated plasma triglyceride concentration is a common biochemical finding, but the evidence for the benefit of treating this lipid disturbance remains less robust than that for treating elevated low-density lipoprotein-cholesterol. Part of the difficulty in the provision of specific recommendations has been the frequent coexistence of elevated triglycerides with other conditions that affect cardiovascular disease risk, such as depressed high-density lipoprotein-cholesterol, obesity, metabolic syndrome, proinflammatory and prothrombotic biomarkers, and type 2 diabetes. Recent investigations of outcomes of cardiovascular disease when medications are used to reduce triglyceride levels suggest that, although a net benefit probably exists, both relative and absolute risk reductions seem underwhelming when compared with the benefit of reducing low-density lipoprotein-cholesterol levels with treatment. However, the totality of evidence suggests that elevated triglyceride levels likely contribute independently to increased risk of cardiovascular disease, although there is no consensus about appropriate target levels. Furthermore, severe hypertriglyceridemia is associated with an increased risk of acute pancreatitis, irrespective of its effect on risk of cardiovascular disease. We review the causes and classification of elevated triglyceride levels, the clinical manifestations of primary hypertriglyceridemia and the management of patients with elevated triglyceride levels.
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“Effectiveness of omega-3 fatty acids, routinely used in pharmacologic doses for treatment of severe HTG, has been inconsistent in patients with FCS.3,[16][17][18]20”
From Familial chylomicronemia syndrome: Bringing to life dietary recommendations throughout the life span (2018) · cites this paper as [17]
In the citing paper
“Of note, prescription omega-3 fatty acids (up to 4 grams per day) have shown inconsistent effectiveness as a treatment for HTG in patients with FCS.3,[16][17][18][19]”
From Familial chylomicronemia syndrome: Bringing to life dietary recommendations throughout the life span (2018) · cites this paper as [17]
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“In adults at risk of atherosclerosis, hypertriglyceridemia is commonly associated with low high density lipoprotein-cholesterol (HDL-C) which is, in turn, a powerful predictor of adverse cardiovascular events [5].”
BackgroundType V hypertriglyceridemia in children, a therapeutic challenge in pediatrics
Mărginean, C. O., Meliţ, L. E., Dobreanu, M., & Săsăran, M. O. (2017) · Medicine · doi:10.1097/md.0000000000008864 · Cited by 10
“multiple genetic factors, being defined as multigenic or polygenic.([5]) Therefore, HTg in individuals that carry a genetic susceptibility is further exacerbated by exposure to nongenetic secondary factors, such as overweight/obesity or alcohol abuse.”
BackgroundInfluentialWoo, Y., Shin, J.-S., Shim, C. Y., Kim, J., Kim, B., Park, S., Chang, H., Hong, G., Ko, Y., Kang, S., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0205006 · Cited by 11
El-Koofy, N. M., Abdo, Y. A., El-Fayoumi, D. M. S., Esmael, A. F., Elmonem, M. A., & Ezzeldin, Z. (2021) · Lipids in Health and Disease · doi:10.1186/s12944-021-01464-2 · Cited by 10
Ratajczak, J. M., Kubica, A., Michalski, P., Pietrzykowski, Ł., Białczyk, A., Kosobucka, A., Bergmann, K., Buczkowski, K., Krintus, M., Jankowski, P., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12072738 · Cited by 13
“Obesity and history of DM were independent risk factors of abnormal TG concentration in the current analysis, similar to other observational studies [7,12,23].”
BackgroundResultAn Evidence Map of Systematic Reviews to Inform Interventions in Prediabetes
Singh, K., Ansari, M. T., Galipeau, J., Garritty, C., Keely, E., Malcolm, J., Pratt, M., Skidmore, B., & Sorisky, A. (2012) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2012.06.004 · Cited by 11
Acute Pancreatitis Secondary to Gestational Hypertriglyceridaemia
Cahalane, A. M., Smith, M. J. F., Ryan, J., & Maguire, D. (2012) · Case Reports in Medicine · doi:10.1155/2012/627890 · Cited by 10
“HTG can be categorized as primary and secondary, although an underlying molecular basis can be found in less than 5% of cases [9].”
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“It is a known fact that food intake, especially increased carbohydrate intake, is a common reason for elevated triglycerides [24].”
Guichelaar, T., van Erp, E. A., Hoeboer, J., Smits, N. A. M., van Els, C. A. C. M., Pieren, D. K. J., & Luytjes, W. (2018) · Developmental & Comparative Immunology · doi:10.1016/j.dci.2017.12.026 · Cited by 10
Severe Hypertriglyceridemia due to a novel p.Q240H mutation in the Lipoprotein Lipase gene
Soto, A. G., McIntyre, A. D., Agrawal, S., Bialo, S. R., Hegele, R. A., & Boney, C. M. (2015) · Lipids in Health and Disease · doi:10.1186/s12944-015-0107-1 · Cited by 11
“Pancreatitis is common in these patients and risk increases with TG levels over 1,000 mg/dl [14].”
Lu, J. J.-Y., Jiang, D. D., Chou, S.-M., Hor, C., Lay, J., & Wang, H. (2008) · The Kaohsiung Journal of Medical Sciences · doi:10.1016/s1607-551x(08)70142-6 · Cited by 10
“In addition, elevated blood triglyceride levels are correlated with obesity and boost the risk of cardiovascular disease and/or acute pancreatitis whenever the patient’s triglyceride levels are very high [22].”
Wang, Y., Fang, Y., & Vrablı́k, M. (2024) · Diagnostics · doi:10.3390/diagnostics14070733 · Cited by 9
“Low-density lipoprotein (LDL) cholesterol [11], insulin resistance [12,13], and inflammation [14,15] emerge as potential players in elucidating this association.”
BackgroundInfluentialHypertriglyceridemia in a Pediatric Referral Practice: Experience With 300 Patients
de Ferranti, S. D., Crean, S. M., Cotter, J., Boyd, D., & Osganian, S. K. (2010) · Clinical Pediatrics · doi:10.1177/0009922810379498 · Cited by 9
Lipoprotein Lipase Deficiency in an Infant With Chylomicronemia, Hepatomegaly, and Lipemia Retinalis
Vidanapathirana, D. M., Rodrigo, T., Waidyanatha, S., Jasinge, E. A., Hooper, A. J., & Burnett, J. R. (2017) · Global Pediatric Health · doi:10.1177/2333794x17715839 · Cited by 9
“Pancreatitis is common in these patients and risk increases with triglyceride levels greater than 1000 mg/dL.(8)Most clinical signs and symptoms of LPL deficiency are attributed to the hypertriglyceridemia.”
BackgroundNeonatal hyperlipidemia with pancreatitis
Shah, M., Roshan, R., Desai, R., & Kadam, S. (2018) · Journal of Postgraduate Medicine · doi:10.4103/jpgm.jpgm_731_17 · Cited by 9
“[9,10] Hyperchylomicronemia-induced recurrent pancreatitis occurs when triglyceride level exceeds 2,000 mg/dL leading to pancreatic insufficiency, which is the major complication of this disease.”
Risk Factors for Acute Kidney Injury in Acute Pancreatitis
Yu, B., He, W., & Lü, N. (2020) · Pancreas · doi:10.1097/mpa.0000000000001613 · Cited by 9
65-jähriger Patient mit gelb-orange farbenen Papeln an beiden Unterarmen
Streit, E., & Helmbold, P. (2009) · Der Hautarzt · doi:10.1007/s00105-009-1847-5 · Cited by 9
“Bei den Hyperlipoproteinämien vom Typ II– IV ist zusätzlich das Arterioskleroserisiko aufgrund von Lipidablagerungen in den arteriellen Gefäßwänden zum Teil massiv erhöht [10].”
BackgroundDislipidemia relacionada à fibrose cística
Alves, C., & Lima, D. S. (2008) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37132008001000012 · Cited by 9
Dysbetalipoproteinemia: Two cases report and a diagnostic algorithm
Kei, A. A. (2015) · World Journal of Clinical Cases · doi:10.12998/wjcc.v3.i4.371 · Cited by 9
Macedo, R. C. O., Boeno, F. P., Farinha, J. B., Ramis, T. R., Rodrigues-Krause, J. D. C., Vieira, A., Queiroz, J. D. N., Moritz, C. E. J., & Reischak-Oliveira, Á. (2018) · European Journal of Nutrition · doi:10.1007/s00394-018-1780-4 · Cited by 10
Sardar, M. B., Raza, M., Fayyaz, A., Nadir, M. A., Nadeem, Z. A., & Babar, M. (2024) · Cardiovascular Toxicology · doi:10.1007/s12012-024-09913-x · Cited by 9
Approach to the Adult Patient with Chylomicronemia
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“Therefore, folate may have a regulatory role in the metabolism of triglycerides. High concentrations of serum triglycerides are a well-documented risk factor for CVD in most populations [ ,”
BackgroundChanges in Serum Lipid Profiles among Canine Patients Suffering from Chronic Hepatitis
Assawarachan, S. N., Chuchalermporn, P., Maneesaay, P., & Thengchaisri, N. (2021) · Veterinary Sciences · doi:10.3390/vetsci8100221 · Cited by 8
TAME-Esterase and Oxidative Stress Contribute to Dysmetabolic Syndrome in Dyslipidaemia
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Quetiapine is associated with pancreatitis: A real-world pharmacovigilance study
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“For example, triglyceride levels are particularly sensitive to prandial state and other influences (Yuan et al., 2007).”
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Metadata
- Authors
- Yuan, G., Al-Shali, K. Z., & Hegele, R. A.
- Affiliations
- Western University (CA)
- Corresponding author
- Hegele, R. A.
- ORCID
- Hegele, R. A.
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Impact Inc.
- Published
- 2007-04-10
- Volume
- 176
- Issue
- 8
- Pages
- 1113-1120
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC1839776
- OpenAlex
- W1982040758
- Cited by
- 624
- References
- 77
- Citations by year
- 2026: 26 · 2025: 24 · 2024: 42 · 2023: 30 · 2022: 35 · 2021: 36 · 2020: 40 · 2019: 25 · 2018: 31 · 2017: 31 · 2016: 35 · 2015: 35 · 2014: 29 · 2013: 32 · 2012: 35
- FWCI
- 5.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Genome Canada
- Ontario Genomics
- Ontario Genomics Institute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- hypertriglyceridemia, triglyceride-lowering therapy, cardiovascular risk, acute pancreatitis, primary hypertriglyceridemia, LDL cholesterol, HDL cholesterol, metabolic syndrome, type 2 diabetes, pro-inflammatory markers
- MeSH terms
- Hypolipidemic Agents, Clofibric Acid, Coronary Artery Disease, Diet, Humans, Niacin, Pancreatitis, Risk Factors, Triglycerides, Hypertriglyceridemia, Weight Loss, Exercise, Practice Guidelines as Topic, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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