| A physician's guide for the management of hypertriglyceridemia: the etiology of hypertriglyceridemia determines treatment strategy. | |
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MedLine Citation:
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PMID: 22525564 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Hypertriglyceridemia is a common lipid disorder associated to different, highly prevalent metabolic derangements like diabetes mellitus, the metabolic syndrome and obesity. The choice of treatment depends on the underlying pathogenesis and the consequences for atherosclerosis or pancreatitis. A family history, physical examination and analysis of the lipid profile including measurement of apolipoprotein B or non-HDL-C are necessary to establish the underlying primary or secondary cause. Due to physiological diurnal variations of triglycerides (TG), the time of measurement (fasting or postprandial) should be taken into account when evaluating TG values. Increased awareness arises concerning the impact of postprandial hypertriglyceridemia on the development of atherosclerosis. Hypertriglyceridemia is strongly associated to postprandial hyperlipidemia, remnant accumulation, increased small dense LDL concentrations, low HDL-C, increased oxidative stress, endothelial dysfunction, leukocyte activation and insulin resistance. All these factors are strongly linked to the development of atherosclerosis. Treatment should be aimed at reducing the secretion of triglyceride-rich lipoproteins, increasing intravascular lipolysis and reducing the number of circulating remnants. The main intervention is a change of lifestyle with decreased alcohol consumption, increased physical activity, dietary changes and, if applicable, adaptation of used medication. Fibrates, fish oil and nicotinic acid are the first choice of treatment in sporadic and familial hypertriglyceridemia to reduce the risk of pancreatitis, whereas high dose statins, sometimes in combination with fibrates, nicotinic acid, or fish oil capsules, are indicated for familial combined hyperlipidemia. Statins are necessary to reach low LDL-C concentrations in patients with type 2 diabetes mellitus and statin dosage should be increased when hypertriglyceridemia is present to reach secondary treatment targets for apolipoprotein B or non-HDL-C. Finally, family screening is mandatory to detect familial lipid disorders for early intervention in other family members. |
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Authors:
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B Klop; J Wouter Jukema; T J Rabelink; M Castro Cabezas |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Panminerva medica Volume: 54 ISSN: 1827-1898 ISO Abbreviation: Panminerva Med Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-04-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0421110 Medline TA: Panminerva Med Country: Italy |
Other Details:
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Languages: eng Pagination: 91-103 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Diabetes and Vascular Center, Sint Franciscus Gasthuis Rotterdam, the Netherlands - m.castrocabezas@sfg.nl. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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