Pediatric Hypertriglyceridemia: Lipoprotein Metabolism, Etiology, and Management

Hypertriglyceridemia increases the risk of both atherosclerotic cardiovascular disease and acute pancreatitis. While management of dyslipidemia has long been a focus in the care of adult patients, relatively recent recommendations for universal pediatric lipid screening have facilitated earlier and more widespread diagnoses of dyslipidemia in youth. This review highlights lipoprotein metabolism, etiologic classifications, and management strategies to guide clinicians in identifying and treating hypertriglyceridemia in children and adolescents.

Novel therapies targeting lipoprotein pathways, particularly angiopoietin-like 3 and apolipoprotein C-III inhibitors, show promise in reducing triglyceride levels among patients with inherited or treatment-refractory conditions. These agents build upon established options (fibrates, omega-3 fatty acid preparations, and statins) that have been adapted from adult practice for pediatric use.

A comprehensive approach to pediatric hypertriglyceridemia integrates lifestyle interventions with pharmacotherapy for those whose levels remain elevated. Timely identification of underlying etiologies, such as obesity, medication-induced hypertriglyceridemia, and rare genetic mutations, is vital. Intervention for extremely high triglyceride levels can mitigate acute pancreatitis risk, while even modest reductions may improve long-term cardiovascular outcomes. By combining appropriate screening, prompt evaluation, and individualized therapies, clinicians can reduce both immediate and long-term complications, thereby improving overall cardiometabolic health in children and adolescents.