Evaluation and Treatment of Hypertriglyceridemia

Publication Date: September 1, 2012

Recommendations

Diagnosis and Definitions

Severe and very severe hypertriglyceridemia increase the risk for pancreatitis, whereas mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease. Therefore, similar to the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guideline committee’s recommendations, the Endocrine Society recommends screening adults for hypertriglyceridemia as part of a lipid panel at least every 5 yr. (1, L)
700
Base the diagnosis of hypertriglyceridemia on fasting triglyceride levels and not on nonfasting triglyceride levels. (1, M)
700
AVOID the routine measurement of lipoprotein particle heterogeneity in patients with hypertriglyceridemia. (1, L)
700
Measurement of apolipoprotein B (apoB) or lipoprotein(a) [Lp(a)] levels can be of value, whereas measurement of other apolipoprotein levels has little clinical value. (2, L)
700

Causes of elevated triglycerides—primary and secondary

We recommend that individuals found to have any elevation of fasting triglycerides should be evaluated for secondary causes of hyperlipidemia including endocrine conditions and medications. Treatment should be focused on such secondary causes. (1, L)
700
We recommend that patients with primary hypertriglyceridemia be assessed for other cardiovascular risk factors, such as central obesity, hypertension, abnormalities of glucose metabolism, and liver dysfunction. (1, L)
700
We recommend that clinicians evaluate patients with primary hypertriglyceridemia for family history of dyslipidemia and cardiovascular disease to assess genetic causes and future cardiovascular risk. (1, L)
700

Management of hypertriglyceridemia

We recommend lifestyle therapy, including dietary counseling to achieve appropriate diet composition, physical activity, and a program to achieve weight reduction in overweight and obese individuals as the initial treatment of mild-to-moderate hypertriglyceridemia. (1, L)
700
For severe and very severe hypertriglyceridemia (>1000 mg/dl), we recommend combining reduction of dietary fat and simple carbohydrate intake with drug treatment to reduce the risk of pancreatitis. (1, H)
700
We recommend that the treatment goal for patients with moderate hypertriglyceridemia be a non-high-density lipoprotein (HDL) cholesterol level in agreement with NCEP ATP guidelines. (1, L)
700
We recommend that a fibrate be used as a first-line agent for reduction of triglycerides in patients at risk for triglyceride-induced pancreatitis. (1, M)
700
We suggest that three drug classes (fibrates, niacin, n-3 fatty acids) alone or in combination with statins be considered as treatment options in patients with moderate to severe triglyceride levels. (2, L)
700
We recommend that statins not be used as monotherapy for severe or very severe hypertriglyceridemia. However, statins may be useful for the treatment of moderate hypertriglyceridemia when indicated to modify cardiovascular risk. (1, L)
700

Recommendation Grading

Disclaimer

Overview

Title

Evaluation and Treatment of Hypertriglyceridemia

Authoring Organization

Publication Month/Year

September 1, 2012

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Dietician nutritionist, diabetes educator, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D015228 - Hypertriglyceridemia

Keywords

triglycerides, hypertriglyceridemia

Source Citation

Lars Berglund, John D. Brunzell, Anne C. Goldberg, Ira J. Goldberg, Frank Sacks, Mohammad Hassan Murad, Anton F. H. Stalenhoef, Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 9, 1 September 2012, Pages 2969–2989, https://doi.org/10.1210/jc.2011-3213