• September 29, 2012 – 11:25

    Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline

    Hypertriglyceridemia is a known risk factor for both cardiovascular disease and pancreatitis. The National Cholesterol Education Program Adult Treatment Panel  (NCEP ATP) III Guidelines from 2001 have recommended screening adults for hypertriglyceridemia as part of a fasting lipid panel at least once every 5 years.  A recent Endocrine Society Task Force convened to review existing guidelines for evaluation and treatment of hypertriglyceridemia. 

    The Task Force recommends the following:

    • Diagnosis of hypertriglyceridemia should be based upon fasting triglyceride levels
    • Measurement of aoplipoprotein B or lipoprotein (a) may be of value
    • Patients with elevated fasting triglycerides should be evaluated for secondary causes of hyperlipidemia including endocrine conditions and medications
    • Patients with primary hypertriglyceridemia should be evaluated for additional cardiovascular risk factors including central obesity, hypertension, impaired glucose metabolism, and liver dysfunction
    • Patients with primary hypertriglyceridemia should be evaluated for a family history of dyslipidemia and cardiovascular disease to assess genetic causes as well as future risk
    • Lifestyle therapy, including dietary counseling and physical activity, should be promoted to achieve weight reduction in obese patients
    • For severe hypertriglyceridemia (> 1000mg/dl), pharmacotherapy should be prescribed along with dietary fat and simple carbohydrate reduction to reduce the risk of pancreatitis
    • Fibrates should be used as first-line agents for reduction of triglycerides in patients at risk for triglyceride-induced pancreatitis
    • Fibrates, niacin, and α-3 fatty acids alone or in combination with statins should be considered as treatment options in patients with moderate to severe hypertriglyceridemia
    • Statins should not be used as monotherapy for severe or very severe hypertriglyceridemia, but may be used for treatment of moderate hypertriglyceridemia when indicated to modify cardiovascular risk

    Reference: Berglund L, Brunzell JD, Goldberg AC, et al.  Evaluation and treatment of hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline