Hhypertriglyceridemia

Hypertriglyceridemia is a commonly encountered but often overlooked component in the evaluation of dyslipidemias. Although the importance of elevated tnglycendes as a nsk factor for atherogenesis has not been clarified, recent evidence suggests it may be more important than previously recognized. An appreciation of hpoprotein metabolism provides the foundation thr understanding the mechanisms by which triglycerides become elevated in the serum.

Hypertriglyceridemia may occur as a primary disorder due to a variety of enzymatic and/ or genetic defects or as a secondary disorder associated with a number of medical conditions. A comprehensive treatment plan includes nonpharmacologic measures as first-line therapy, effective management of secondary causes, and, when indicated, drug therapy with fIbric acid or nicotinic acid derivatives. A working knowledge of the therapeutic options, their expected impact, and possible side effects are essential. This article will review the etiologies, complications, and management of hypertriglyceridemia. The importance of triglycerides as an independent nsk factor thr coronary artery disease has not been completely delineated.1 2 Data from population—based studies have suggested that an elevated triglyceride level is an independent nsk factor thr cardiovascular events.3 In 2 prospective trials, the Physician's Health Study4 and the Copenhagen Male Study5 triglyceride levels were also found to be independent predictors of coronary heart disease (CHD). The Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial found that a 31% decrease in tnglycende levels and 6% increase in high-density lipoprotein (HDL) levels after treatment with gemfibrozil resulted in a 22% relative nsk reduction for a primary coronary event.6 However, other prospective trials have failed to yield similar findings, and the issue of whether triglyceride levels are an independent predictor of CHD remains unsettledt2'7 Even though a consensus has not been reached. The prevalence of dyslipidemia varies with the population being studied. The percentage of adults in the United States with triglyceride levels above 150 mg/dL (1.7 mmol/L), 200 mg/dL (2.3 mmol/L), 500 mg/dL (5.7 mmol/L), and 1000 mg/dL (11.3 mmol/L) is 33, 18, 1.7, and 0.4 percent, respectively [2]. The incidence is highest in patients with premature coronary disease (CHD), which can be defined as occurring before 55 years of age in men and before 65 years in women. In such patients, the prevalence of dyslipidemia is as high as 80 to 88 percent, compared to approximately 40 to 48 percent in age-matched controls without coronary heart disease. The disturbance in lipoprotein metabolism is often familial. In one study of 102 kindred in which the proband had premature coronary disease, 54 percent of all patients (and 70 percent of those with a lipid abnormality) had a familial lipid disorder [3]. The most common were lipoprotein(a) excess (alone or with other dyslipidemia), hypertriglyceridemia with hypoalphalipoproteinemia, and combined hyperlipidemia. Because of the association among dyslipidemia, premature CHD, and a family history of CHD, a screening lipid analysis is recommended for first-degree relatives of patients with premature CHD. Screening should begin with a standard lipid profile. Further testing may include measurement of Lp(a) and apo B levels. Approximately 25 percent of patients with ...