Editing Hypertriglyceridemia

{{short description|High triglyceride blood levels}}
{{Infobox medical condition (new)
| name = Hypertriglyceridemia
| synonyms = Elevated levels of triglycerides
| image = Hypertriglyceridämie.jpg
| caption = Blood samples of a young patient with extreme hypertriglyceridemia
| pronounce =
| field = [[Endocrinology]]
| symptoms =
| complications = [[Heart disease]], [[pancreatitis]]
| onset =
| duration =
| types =
| causes =
| risks = [[Metabolic dysfunction-associated steatotic liver disease]], [[atherosclerosis]], [[alcoholism]], [[metabolic syndrome]]
| diagnosis =
| differential = [[Hyperlipidemia]], [[atheroma]], [[hypercholesterolemia]], [[hypercalcemia]]
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}

'''Hypertriglyceridemia''' is the presence of high amounts of [[triglyceride]]s in the [[blood]]. Triglycerides are the most abundant [[fat]]ty molecule in most organisms.  Hypertriglyceridemia occurs in various physiologic conditions and in various diseases, and high triglyceride levels are associated with [[atherosclerosis]], even in the absence of [[hypercholesterolemia]] (high [[cholesterol]] levels) and predispose to [[cardiovascular disease]].

Chronically elevated serum triglyceride levels are a component of [[metabolic syndrome]] and [[Metabolic dysfunction–associated steatotic liver disease|metabolic dysfunction-associated steatotic liver disease]], both of which typically involve [[obesity]] and contribute significantly to cardiovascular mortality in industrialised countries as of 2021. Extreme triglyceride levels also increase the risk of [[acute pancreatitis]].

Hypertriglyceridemia itself is usually symptomless, although high levels may be associated with skin lesions known as ''[[xanthoma]]s''.<ref name=CPG2012/>

==Signs and symptoms==
Most people with elevated triglycerides experience no symptoms. Some forms of primary hypertriglyceridemia can lead to specific symptoms: both familial chylomicronemia and primary [[Combined hyperlipidemia|mixed hyperlipidemia]] include skin symptoms (eruptive [[xanthoma]]), eye abnormalities ([[lipaemia retinalis]]), [[hepatosplenomegaly]] (enlargement of the [[liver]] and [[spleen]]), and neurological symptoms. Some experience attacks of abdominal pain that may be mild episodes of pancreatitis. Eruptive xanthomas are 2–5&nbsp;mm papules, often with a red ring around them, that occur in clusters on the skin of the trunk, buttocks and extremities.<ref name="Yuan2007">{{cite journal | vauthors = Yuan G, Al-Shali KZ, Hegele RA | title = Hypertriglyceridemia: its etiology, effects and treatment | journal = CMAJ | volume = 176 | issue = 8 | pages = 1113–1120 | date = April 2007 | pmid = 17420495 | pmc = 1839776 | doi = 10.1503/cmaj.060963 }}</ref> [[Familial dysbetalipoproteinemia]] causes larger, tuberous xanthomas; these are red or orange and occur on the elbows and knees. Palmar crease xanthomas may also occur.<ref name="CPG2012">{{cite journal | vauthors = Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH, Stalenhoef AF |author4-link=Ira Goldberg | title = Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 97 | issue = 9 | pages = 2969–2989 | date = September 2012 | pmid = 22962670 | pmc = 3431581 | doi = 10.1210/jc.2011-3213 }}</ref><ref name="Yuan2007" />

The diagnosis is made on [[blood test]]s, often performed as part of [[Screening (medicine)|screening]]. Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.<ref name=CPG2012/>
[[File:Fat triglyceride shorthand formula.svg|thumb|right|[[Triglyceride]], which cause hypertriglyceridemia at high level]]

[[Acute pancreatitis]] may occur in people whose triglyceride levels are above 1000&nbsp;mg/dL (11.3&nbsp;mmol/L).<ref name=CPG2012/><ref name=Yuan2007/><ref name="Tsuang2009">{{cite journal | vauthors = Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A | title = Hypertriglyceridemic pancreatitis: presentation and management | journal = The American Journal of Gastroenterology | volume = 104 | issue = 4 | pages = 984–991 | date = April 2009 | pmid = 19293788 | doi = 10.1038/ajg.2009.27 | s2cid = 24193233 }}</ref> Hypertriglyceridemia is associated with 1–4% of all cases of pancreatitis. The symptoms are similar to pancreatitis secondary to other causes, although the presence of xanthomas or risk factors for hypertriglyceridemia may offer clues.<ref name=Tsuang2009/>

==Causes==

{{colbegin}}
* [[Overeating]]<ref>{{cite journal | vauthors = Garg A, Grundy SM, Unger RH | title = Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM | journal = Diabetes | volume = 41 | issue = 10 | pages = 1278–1285 | date = October 1992 | pmid = 1397701 | doi = 10.2337/diabetes.41.10.1278 }}</ref><ref name=Pej2006/>
* [[Obesity]]
* [[Diabetes mellitus]] and [[insulin resistance]] - it is one of the defined components of [[metabolic syndrome]] (along with [[central obesity]], [[hypertension]], and [[hyperglycemia]])
* Excess [[alcohol consumption]]
* [[Kidney failure]], [[nephrotic syndrome]]
* Genetic predisposition; some forms of familial [[hyperlipidemia]] such as familial [[combined hyperlipidemia]] i.e. Type II hyperlipidemia
* [[Lipoprotein lipase deficiency]] - Deficiency of this water-soluble [[enzyme]], that hydrolyzes [[triglyceride]]s in [[lipoprotein]]s, leads to elevated levels of triglycerides in the blood.
* [[Lysosomal acid lipase deficiency]] or [[Cholesteryl ester storage disease]]
* Certain medications e.g. [[isotretinoin]], [[hydrochlorothiazide]] diuretics, [[beta blockers]], [[protease inhibitors]]
* [[Hypothyroidism]] (underactive thyroid)
* [[Lupus]] and associated autoimmune responses <ref>{{cite journal | vauthors = Beigneux AP, Miyashita K, Ploug M, Blom DJ, Ai M, Linton MF, Khovidhunkit W, Dufour R, Garg A, McMahon MA, Pullinger CR, Sandoval NP, Hu X, Allan CM, Larsson M, Machida T, Murakami M, Reue K, Tontonoz P, Goldberg IJ, Moulin P, Charrière S, Fong LG, Nakajima K, Young SG | display-authors = 6 | title = Autoantibodies against GPIHBP1 as a Cause of Hypertriglyceridemia | journal = The New England Journal of Medicine | volume = 376 | issue = 17 | pages = 1647–1658 | date = April 2017 | pmid = 28402248 | pmc = 5555413 | doi = 10.1056/NEJMoa1611930 }}</ref>
* Glycogen storage disease type 1.
* [[Propofol]]
* HIV medications
{{colend}}

==Diagnosis==
The diagnosis is made on [[blood test]]s, often performed as part of [[Screening (medicine)|screening]]. The normal triglyceride level is less than 150&nbsp;mg/dL (1.7&nbsp;mmol/L).<ref name=CPG2012/><ref name="Pej2006">{{cite journal | vauthors = Pejic RN, Lee DT | title = Hypertriglyceridemia | journal = Journal of the American Board of Family Medicine | volume = 19 | issue = 3 | pages = 310–316 | date = May–Jun 2006 | pmid = 16672684 | doi = 10.3122/jabfm.19.3.310 | doi-access = free }}</ref>  Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.<ref name=CPG2012/>

=== Guidelines ===
[[File:Blood_values_sorted_by_mass_and_molar_concentration.png|thumb|450x450px|[[Reference ranges for blood tests]], showing usual ranges for triglycerides (increasing with age) in orange at right.]]
The [[National Cholesterol Education Program]] has set guidelines for triglyceride levels:<ref name="NCEP-triglycerides">{{cite web |title=Triglycerides |url=https://www.nlm.nih.gov/medlineplus/ency/article/003493.htm |archive-url=https://web.archive.org/web/20140228062757/http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Triglycerides_UCM_306029_Article.jsp |archive-date=28 February 2014 |access-date=2015-04-23 |website=MedlinePlus}}</ref><ref>Crawford, H., Micheal. ''Current Diagnosis & Treatment Cardiology''. 3rd ed. McGraw-Hill Medical, 2009. p19</ref>
{| class="wikitable"
! colspan="2" |Level
! rowspan="2" |Interpretation
|-
!([[Milligram|mg]]/[[Decilitre|dL]])
!([[Mole (unit)|mmol]]/[[Litre|L]])
|-
|<&nbsp;150
|<&nbsp;1.70
|Normal range&nbsp;– low risk
|-
|150–199
|1.70–2.25
|Slightly above normal
|-
|200–499
|2.26–5.65
|Some risk
|-
|500 or higher
|>&nbsp;5.65
|Very high&nbsp;– high risk
|}
These levels are tested after [[Fasting#Medical application|fasting]] 8 to 12 hours. Triglyceride levels remain temporarily higher for a period after eating.

The AHA recommends an optimal triglyceride level of 100{{nbs}}mg/dL (1.1{{nbs}}mmol/L) or lower to improve heart health.<ref>{{cite web |date=28 September 2012 |title=What's considered normal? |url=http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186 |website=Triglycerides: Why do they matter? |publisher=[[Mayo Clinic]]}}</ref>

==Screening==
In 2016, the [[United States Preventive Services Task Force]] concluded that testing the general population under the age of 40 without symptoms is of unclear benefit.<ref>{{cite journal | vauthors = Chou R, Dana T, Blazina I, Daeges M, Bougatsos C, Jeanne TL | title = Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force | journal = Annals of Internal Medicine | volume = 165 | issue = 8 | pages = 560–564 | date = October 2016 | pmid = 27538032 | doi = 10.7326/M16-0946 | s2cid = 20592431 }}</ref><ref>{{cite journal | vauthors = Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, Gillman MW, Kemper AR, Krist AH, Kurth AE, Landefeld CS, LeFevre M, Mangione CM, Owens DK, Phillips WR, Phipps MG, Pignone MP, Siu AL | display-authors = 6 | title = Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 316 | issue = 6 | pages = 625–633 | date = August 2016 | pmid = 27532917 | doi = 10.1001/jama.2016.9852 | doi-access = free }}</ref>

==Treatment==
Lifestyle changes including weight loss, exercise and dietary modification may improve hypertriglyceridemia.<ref>{{Cite journal | vauthors = Koneru SC |date=2022-03-01 |title=Fellow's voice: Hypertriglyceridemia: Understanding the current guideline  |journal=American Journal of Preventive Cardiology |language=en |volume=9 |pages=100322 |doi=10.1016/j.ajpc.2022.100322 |pmid=35243465 |issn=2666-6677 |pmc=8885448}}</ref><ref name=CPG2012/><ref name="Nordestgaard2014">{{cite journal | vauthors = Nordestgaard BG, Varbo A | title = Triglycerides and cardiovascular disease | journal = Lancet | volume = 384 | issue = 9943 | pages = 626–635 | date = August 2014 | pmid = 25131982 | doi = 10.1016/S0140-6736(14)61177-6 | s2cid = 33149001 }}</ref><ref>{{cite journal | vauthors = Gill JM, Herd SL, Tsetsonis NV, Hardman AE | title = Are the reductions in triacylglycerol and insulin levels after exercise related? | journal = Clinical Science | volume = 102 | issue = 2 | pages = 223–231 | date = February 2002 | pmid = 11834142 | doi = 10.1042/cs20010204 }}</ref> This may include dietary changes such as restriction of fat and carbohydrates (specifically [[fructose]]<ref name="Nordestgaard2014"/><ref>{{Cite journal |last=European Association for Cardiovascular Prevention & Rehabilitation |last2=Reiner |first2=Zeljko |last3=Catapano |first3=Alberico L. |last4=De Backer |first4=Guy |last5=Graham |first5=Ian |last6=Taskinen |first6=Marja-Riitta |last7=Wiklund |first7=Olov |last8=Agewall |first8=Stefan |last9=Alegria |first9=Eduardo |last10=Chapman |first10=M. John |last11=Durrington |first11=Paul |last12=Erdine |first12=Serap |last13=Halcox |first13=Julian |last14=Hobbs |first14=Richard |last15=Kjekshus |first15=John |date=July 2011 |title=ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) |url=https://pubmed.ncbi.nlm.nih.gov/21712404/ |journal=European Heart Journal |volume=32 |issue=14 |pages=1769–1818 |doi=10.1093/eurheartj/ehr158 |issn=1522-9645 |pmid=21712404}}</ref> and [[sugar-sweetened beverages]]<ref name="CPG2012"/>) and increased consumption of [[omega-3 fatty acid]]s from algae, nuts, and seeds.<ref name="TheLipid2008">{{cite book | vauthors = Davidson MH, Cannon CP, Armani AM | veditors = Davidson MH, Toth PP, Maki KC |title= Therapeutic Lipidology  |url=https://archive.org/details/therapeuticlipid00davi |url-access=limited |chapter = Pharmacological Therapy for Cardiovascular Disease |pages= [https://archive.org/details/therapeuticlipid00davi/page/n155 141]–142 |series  = Contemporary Cardiology|date= 28 January 2008 |publisher=Humana Press, Inc. |location  = Totowa, New Jersey|isbn = 978-1-58829-551-4}}</ref><ref>{{cite journal | vauthors = Anagnostis P, Paschou SA, Goulis DG, Athyros VG, Karagiannis A | title = Dietary management of dyslipidaemias. Is there any evidence for cardiovascular benefit? | journal = Maturitas | volume = 108 | pages = 45–52 | date = February 2018 | pmid = 29290214 | doi = 10.1016/j.maturitas.2017.11.011 | doi-access = free }}</ref>

The decision to treat hypertriglyceridemia with medication depends on the levels and on the presence of other risk factors for cardiovascular disease. Very high levels that would increase the risk of pancreatitis is treated with a drug from the [[fibrate]] class. [[Niacin (substance)|Niacin]] and [[omega-3 fatty acid]]s as well as drugs from the [[statin]] class may be used in conjunction, with statins being the main drug treatment for moderate hypertriglyceridemia where reduction of cardiovascular risk is required.<ref name=CPG2012/> Medications are recommended in those with high levels of triglycerides that are not corrected with lifestyle modifications, with [[fibrate]]s being recommended first.<ref name=CPG2012/><ref>{{cite journal | vauthors = Abourbih S, Filion KB, Joseph L, Schiffrin EL, Rinfret S, Poirier P, Pilote L, Genest J, Eisenberg MJ | display-authors = 6 | title = Effect of fibrates on lipid profiles and cardiovascular outcomes: a systematic review | journal = The American Journal of Medicine | volume = 122 | issue = 10 | pages = 962.e1–962.e8 | date = October 2009 | pmid = 19698935 | doi = 10.1016/j.amjmed.2009.03.030 }}</ref><ref>{{cite journal | vauthors = Jun M, Foote C, Lv J, Neal B, Patel A, Nicholls SJ, Grobbee DE, Cass A, Chalmers J, Perkovic V | display-authors = 6 | title = Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis | journal = Lancet | volume = 375 | issue = 9729 | pages = 1875–1884 | date = May 2010 | pmid = 20462635 | doi = 10.1016/S0140-6736(10)60656-3 | s2cid = 15570639 }}</ref> [[Epanova (omega-3-carboxylic acids)]] is another prescription drug used to treat very high levels of blood triglycerides.<ref>{{cite journal | vauthors = Blair HA, Dhillon S | title = Omega-3 carboxylic acids (Epanova): a review of its use in patients with severe hypertriglyceridemia | journal = American Journal of Cardiovascular Drugs | volume = 14 | issue = 5 | pages = 393–400 | date = October 2014 | pmid = 25234378 | doi = 10.1007/s40256-014-0090-3 | s2cid = 23706094 }}</ref>

== Epidemiology ==
As of 2006, the prevalence of hypertriglyceridemia in the United States was 30%.<ref name=Pej2006/>

==Research==

Analysis of the genes in depression and anxiety showed those linked solely to depression were also linked to hypertriglyceridemia.<ref name="pmid33859377">{{cite journal | vauthors = Thorp JG, Campos AI, Grotzinger AD, Gerring ZF, An J, Ong JS, Wang W, Shringarpure S, Byrne EM, MacGregor S, Martin NG, Medland SE, Middeldorp CM, Derks EM | display-authors = 6 | title = Symptom-level modelling unravels the shared genetic architecture of anxiety and depression | journal = Nature Human Behaviour | volume = 5 | issue = 10 | pages = 1432–1442 | date = October 2021 | pmid = 33859377 | doi = 10.1038/s41562-021-01094-9 | s2cid = 233259875 }}</ref>

==Etymology==
The word ''hypertriglyceridemia'' uses [[classical compound|combining forms]] of ''[[wikt:hyper-#Prefix|hyper-]]'' + ''[[triglyceride]]'' + ''[[wikt:-emia#Suffix|-emia]]'', thus corresponding to "high triglyceride levels in the blood" or "too many triglycerides in the blood".{{cn|date=July 2024}}

== See also ==
* [[Remnant cholesterol]]

== References ==
{{reflist}}

{{Medical resources
|  DiseasesDB      = 6372
|  ICD10           = {{ICD10|E|78|1|e|70}}, {{ICD10|E|78|2|e|70}}, {{ICD10|E|78|3|e|70}}
|  ICD9            = {{ICD9|272.1}}
|  OMIM            = 145750
|  MedlinePlus     = 000397
|  eMedicineSubj   = med
|  eMedicineTopic  = 2921
|  eMedicine_mult  = {{eMedicine2|article|126568}}
|  MeshID          = D015228
}}
== External links ==
* [https://www.emedicinehealth.com/how_can_i_lower_my_triglycerides_quickly/article_em.htm Lowering Triglycerides] (EMedicineHealth.com; October 2020)

{{Lipidemias}}

[[Category:Lipid metabolism disorders]]
[[Category:Medical conditions related to obesity]]

[[ja:脂質異常症#高トリグリセリド血症]]