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Hypertriglyceridemia
Amanda Brahm1, Robert A Hegele
1Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. aberberi@uwo.ca
Insights
Hypertriglyceridemia (HTG) management is evolving, particularly for mild to moderate cases. Current understanding highlights polygenic inheritance and the link between triglycerides and cardiovascular risk, influencing treatment strategies.
Area of Science:
- Lipidology and Cardiology
- Genetics and Molecular Biology
- Cardiovascular Disease Risk Assessment
Background:
- Hypertriglyceridemia (HTG) is prevalent in lipid and cardiology clinics, with severe cases posing a risk for acute pancreatitis.
- The role of triglycerides in atherosclerosis is under re-evaluation, particularly concerning non-fasting measurements and triglyceride-related lipoprotein fractions.
- Evolving understanding of HTG etiology and genetics moves from single-gene disorders to polygenic/multigenic traits, though rare autosomal recessive forms exist.
Purpose of the Study:
- To review the current understanding of hypertriglyceridemia (HTG) etiology, classification, and its evolving role in cardiovascular disease.
- To discuss the complexities in managing mild to moderate HTG and the factors influencing treatment decisions.
- To outline contemporary therapeutic strategies for managing HTG.
Main Methods:
- Literature review and synthesis of current research on hypertriglyceridemia.
- Analysis of evolving concepts in HTG genetics and its association with atherosclerosis.
- Evaluation of clinical guidelines and therapeutic approaches for HTG management.
Main Results:
- The view that triglycerides do not directly contribute to atherosclerosis is changing, with increased focus on non-fasting lipid profiles.
- HTG is increasingly recognized as a polygenic trait, resulting from the combined effects of multiple genetic variants.
- Treatment decisions for HTG are multifactorial, considering severity, co-existing lipid disorders, and overall cardiovascular risk.
Conclusions:
- Management of HTG requires a personalized approach based on individual risk factors and lipid profiles.
- Therapeutic strategies encompass lifestyle modifications, dietary counseling, management of secondary causes, omega-3 fatty acids, and judicious use of pharmacotherapy.
- Continued research is essential to refine the understanding and treatment of HTG, especially in mild to moderate cases.
Abstract:
Hypertriglyceridemia (HTG) is commonly encountered in lipid and cardiology clinics. Severe HTG warrants treatment because of the associated increased risk of acute pancreatitis. However, the need to treat, and the correct treatment approach for patients with mild to moderate HTG are issues for ongoing evaluation. In the past, it was felt that triglyceride does not directly contribute to development of atherosclerotic plaques. However, this view is evolving, especially for triglyceride-related fractions and variables measured in the non-fasting state. Our understanding of the etiology, genetics and classification of HTG states is also evolving. Previously, HTG was considered to be a dominant disorder associated with variation within a single gene. The old nomenclature includes the term "familial" in the names of several hyperlipoproteinemia (HLP) phenotypes that included HTG as part of their profile, including combined hyperlipidemia (HLP type 2B), dysbetalipoproteinemia (HLP type 3), simple HTG (HLP type 4) and mixed hyperlipidemia (HLP type 5). This old thinking has given way to the idea that genetic susceptibility to HTG results from cumulative effects of multiple genetic variants acting in concert. HTG most is often a "polygenic" or "multigenic" trait. However, a few rare autosomal recessive forms of severe HTG have been defined. Treatment depends on the overall clinical context, including severity of HTG, concomitant presence of other lipid disturbances, and the patient's global risk of cardiovascular disease. Therapeutic strategies include dietary counselling, lifestyle management, control of secondary factors, use of omega-3 preparations and selective use of pharmaceutical agents.
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