Assessment and Treatment of Hypertriglyceridemia
(High Triglycerides)
PATIENT GUIDE
Hypertriglyceridemia
Having high levels of triglycerides, or
hypertriglyceridemia, is a common problem. Triglycerides are fats in the blood
(also called lipids). Your body needs some blood fats for energy. But when your
triglyceride levels are too high, these fats may put you at risk for heart
disease, stroke, and other health problems.
Most often, having high triglycerides has no warning
signs. The good news, though, is there is a simple test to find high triglycerides,
and treatments are available.
This guide for patients comes from The Endocrine
Society’s practice guidelines for physicians about the detection and treatment
of hypertriglyceridemia.
What are the effects of high
triglycerides?
It is unclear if high triglycerides alone are a risk
factor for cardiovascular disease (heart disease and stroke). Triglycerides do
not directly cause the plaque that can block your heart’s arteries
(atherosclerosis) and lead to a heart attack. Yet, cholesterol in
triglyceride-rich particles in the blood may add to plaque formation.
Also, many people with high triglycerides have other
lipid problems or other risk factors for heart disease. A high triglyceride
level is one part of the metabolic syndrome, a cluster of risk factors that
increase the risk for heart disease and diabetes.
High triglycerides can affect more than your heart
and blood vessels. Very high triglycerides raise the risk for pancreatitis, an
inflammation of the pancreas. The pancreas is large gland behind the stomach
that makes key hormones like insulin. It helps your body maintain healthy blood
glucose (sugar) levels. Pancreatitis can cause stomach pain and digestive problems.
It can damage the pancreas and, over a long time, can lead to diabetes.
What raises the risk for high
triglycerides?
Triglycerides normally increase with age. They may
become too high for one or more reasons.
Risk factors include:
+ Lifestyle factors:
- Being overweight or obese
- Not getting enough exercise
- Drinking too much alcohol
- Familial (inherited) disorders
- Type 2 diabetes or the metabolic syndrome
- Pregnancy
+ Medications:
- Some “water” pills (thiazide diuretics)
- Beta-blockers
- Estrogen (birth control pills, hormone therapy)
- Isotretinoin for acne
- Corticosteroids for conditions such as asthma and
arthritis
- Certain cholesterol-lowering drugs
- Protease inhibitors for HIV
- Immune suppressants (such as sirolimus)
- Some antipsychotics (mental health medicines)
The most common reasons for high triglycerides
include being overweight, lack of exercise, the metabolic syndrome, type 2
diabetes, and familial combined hyperlipidemia. The latter is a genetic
disorder that runs in the family. It results in high triglycerides, high “bad”
(low-density lipoprotein, or LDL) cholesterol, and low “good” (high-density
lipoprotein, or HDL) cholesterol.
How are high triglycerides found?
A blood test called a lipid panel measures
triglycerides and cholesterol. You should have this test after fasting (not
eating or drinking anything but water) for at least 12 hours.
Adults should get this screening test every five
years or sooner. If you have diabetes, a family history of high triglycerides,
or other risk factors, you may need screening more often, according to the
National Cholesterol Education Program (NCEP) Guidelines.
The NCEP defines borderline-high triglycerides as 150
to 199 milligrams per deciliter (mg/dL) and high triglycerides as 200 to 499
mg/dL. Very high triglycerides are 500 mg/dL or higher. The Endocrine Society
instead defines hypertriglyceridemia by its disease risk (box). Most people
with high triglycerides have levels from 150 to 999 mg/dL, which puts them at
risk for heart disease. Above 2,000 mg/dL poses a high risk for pancreatitis.
Triglyceride Test Results and Disease
Risk
If your triglycerides are above normal, your doctor
will find out if the cause is primary (genetic) or secondary (e.g., due to
hormonal disease or medications). Untreated secondary causes need treatment. If
the cause is a medication, ask your doctor if you can switch to a medicine that
does not raise triglycerides.
Your health care providers may check you for other
risk factors for heart disease, such as high blood pressure, high blood
glucose, and too much fat around your waist. They also may ask about your
family history of abnormal lipids and heart disease. This helps to assess your
future risk for having a heart attack or a stroke.
What is the treatment for high
triglycerides?
The goal of treatment is to lower your triglycerides.
Patients with very severe hypertriglyceridemia should try to lower their
triglycerides below 1,000 mg/dL, to reduce their risk for pancreatitis.
+ Lifestyle changes:
The first step for lowering triglycerides is to lose
weight if you are overweight, exercise often, and eat a healthy diet low in
saturated (bad) fat and sugar. Also, limit the amount of refined, processed
grains you eat, such as white bread, rice, and pasta. Follow your doctor’s
advice about limiting intake of alcohol, which raises triglycerides in some
people.
+ Medications:
Besides lifestyle changes, you may also need drug
treatment. For mildly or moderately high triglycerides, your doctor may
prescribe one of these types of drugs:
- Fibrates, which greatly lower triglycerides and
sometimes raise HDL (good) cholesterol. In the U.S., these prescription drugs
include gemfibrozil and fenofibrate.
- Niacin, or vitamin B3, at doses of 1,000 to 3,000
mg per day, lowers triglycerides and LDL cholesterol and raises HDL
cholesterol. These doses apply to immediate-release (released into the body
right away) niacin, available by prescription or as a supplement. The dose of
sustained-release (released into the body over time) niacin, which is only
available as a supplement, shouldn’t exceed 2,000 mg per day because of the
risk of liver damage.
- Omega-3 (n-3) fatty acids eicosapentaenoic acid
(EPA) and docosahexaenoic acid (DHA) lower triglycerides. These polyunsaturated
(good) fats are found in fatty fish such as salmon. In high doses (3 to 4 g/d),
they can treat high triglycerides. Fish oil supplements have variable
quantities of EPA and DHA ranging from 20–50% therefore the labels must be
reviewed to calculate the amount of omega-3 fatty acids. FDA approved
prescription omega-3 fatty acids contain >80% EPA and DHA. The prescription
omega -3 requires fewer pills and can lower triglycerides by 30-50%.
Your doctor may add a statin to your other drug
treatment. Though statins mainly lower LDL cholesterol, they also can decrease
triglycerides. Some studies show that statins reduce the risk of heart attacks
and strokes. It is unclear if fibrates and niacin prevent heart attacks and
strokes.
If your triglycerides are above 1,000 mg/dL, though,
the first choice of medicine is a fibrate. You may need a statin, too, but
experts advise against treatment with statins alone if your high triglycerides
are severe or very severe. Fibrates are better than statins at lowering
triglycerides. However, people with liver disease or gallbladder disease should
not take fibrates.
Talk to your doctor about the risks and benefits of
all these drugs. Medications do not cure the problem of high triglycerides, so
you will need to take them long term. However, weight loss and other lifestyle
changes can lower high trigylcerides enough to eliminate the need for
medication.
Ask your doctor if you should see an endocrinologist.
This physician specialist can find and treat hormonal causes of high
triglycerides.
September 2012
Editors:
Lars Berglund, MD, PhD, Massachusetts General
Hospital
John Brunzell, MD, University of Washington
Frank M. Sacks, MD, Harvard School of Public Health
Reference:
No comments:
Post a Comment