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14-September-2008 10:43:23 - Hypertriglyceridemia Hypertriglyceridemia Classification and external resources ICD-10 E78.1, E78.2, E78.3 ICD-9 272.1 DiseasesDB 6372 eMedicine med/2921 MeSH D015228 In medicine, hypertriglyceridemia or Hypertriglyceridaemia denotes high hyper- blood levels -emia of triglycerides, the most abundant fatty molecule in most organisms. It has been associated with atherosclerosis, even in the absence of hypercholesterolemia high cholesterol levels. It can also lead to pancreatitis in excessive concentrations. Very high triglyceride levels may also interfere with blood tests; hyponatremia may be reported spuriously pseudohyponatremia. A related term is hyperglyceridemia or hyperglyceridaemia, which refers to a high level of all glycerides, including monoglycerides, diglycerides and triglycerides. Contents 1 Signs and symptoms 2 Causes 3 Treatment 3.1 Primary prevention 3.2 Secondary prevention 4 References Signs and symptoms Modestly elevated triglyceride levels do not lead to any physical symptoms. Higher levels are associated with lipemia retinalis white appearance of the retina, eruptive xanthomas small lumps in the skin, sometimes itchy. Causes Idiopathic constitutional Obesity High sugar diet Diabetes mellitus and insulin resistance - it is one of the defined components of metabolic syndrome along with central obesity, hypertension, and hyperglycemia Excess alcohol intake Nephrotic syndrome Genetic predisposition Certain medications e.g. isotretinoin Hypothyroidism underactive thyroid Treatment Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the diet, as well as with niacin, fibrates and statins three classes of drugs. Increased fish oil intake may substantially lower an individual's triglycerides.123 Clinical practice guidelines by the National Cholesterol Education Program NCEP suggests that pharmacotherapy be considered with a triglycerides level over 200 mg/dl.4 The guidelines state the sum of LDL + VLDL cholesterol termed non-HDL cholesterol total cholesterol - HDL cholesterol as a secondary target of therapy in persons with high triglycerides 200 mg/dL. The goal for non-HDL cholesterol in persons with high serum triglycerides can be set at 30 mg/dL higher than that for LDL cholesterol Table 9 on the premise that a VLDL cholesterol level 30 mg/dL is normal.4 Primary prevention In the Helsinki Heart Study, a randomized controlled trial of asymptomatic men ages 40-55 without heart disease, 600 mg of gemfibrozil twice daily reduced cardiac endpoints at 5 years from 4.14% to 2.73%. This means that 54 patients must be treated for five years to prevent one cardiac event number needed to treat is 54.5 Secondary prevention In the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study VA-HIT, a randomized controlled trial of men with known heart disease HDL cholesterol of 40 mg/dl or less , 600 mg of gemfibrozil twice daily reduced cardiac endpoints nonfatal myocardial infarction or death from coronary causes at 5 years from 21.7% to 17.3%. This means that 23 patients must be treated for five years to prevent one cardiac event number needed to treat is 23.6 References ^ Lipids Online Slides: hypertriglyceridemia, ICAM-1, fish oil, E-selectin. Retrieved on 2007-09-05. ^ Terres W, Beil U, Reimann B, Tiede S, Bleifeld W 1991. Low-dose fish oil in primary hypertriglyceridemia. A randomized placebo-controlled study in German. Zeitschrift für Kardiologie 80 1: 20-4. PMID 2035283. ^ Fish oils in hypertriglyceridemia - Fish Oils Revisited Nutrition Research Newsletter - Find Articles. Retrieved on 2007-09-05. ^ a b Executive Summary of The Third Report of The National Cholesterol Education Program NCEP Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults Adult Treatment Panel III 2001. JAMA 285 19: 2486-97. PMID 11368702. ^ Frick MH, Elo O, Haapa K, et al 1987. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N. Engl. J. Med. 317 20: 1237-45. PMID 3313041. ^ Rubins HB, Robins SJ, Collins D, et al 1999. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N. Engl. J. Med. 341 6: 410-8. doi:10.1056/NEJM199908053410604. PMID 10438259. v d e Lipid metabolism disorders / Inborn error of lipid metabolism - dyslipidemia E78 and E71.3, 272 Hyperlipidemia Hypercholesterolemia/Hypertriglyceridemia Familial hypercholesterolemia, Combined hyperlipidemia - Xanthoma Hypolipoproteinemia Hypoalphalipoproteinemia/HDL Lecithin cholesterol acyltransferase deficiency, Tangier disease Hypobetalipoproteinemia/LDL Abetalipoproteinemia, Apolipoprotein B deficiency Lipodystrophy Barraquer-Simons syndrome Fatty acid metabolism deficiency transport: Carnitine Primary, I, II, -acylcarnitine - Adrenoleukodystrophy beta oxidation: Acyl CoA dehydrogenase Short-chain, Medium-chain, Long-chain 3-hydroxy, Very long-chain - Mitochondrial trifunctional protein deficiency to acetyl-CoA: Malonic aciduria Cholesterol synthesis Smith-Lemli-Opitz syndrome Other Sjögren-Larsson syndrome - Lipomatosis - Adiposis dolorosa - Lipoid proteinosis see also lipid metabolism enzymes, lipoprotein metabolism Retrieved from http://en..org/wiki/Hypertriglyceridemia Categories: Metabolic disorders | Cardiology | Lipid disorders | Medical conditions related to obesity Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Français Polski Português SlovenÅ¡Ä?ina This page was last modified on 26 August 2008, at 18:36
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