In
medicineMedicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
,
hypertriglyceridemia (or "Hypertriglyceridaemia") denotes high (
hyper-) blood levels (
-emia) of
triglycerideis a glyceride in which the glycerol is esterified with three fatty acids. It is the main constituent of vegetable oil and animal fats.- Chemical structure :...
s, the most abundant
fatFats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water. Chemically, fats are generally triesters of glycerol and fatty acids. Fats may be either solid or liquid at normal room temperature, depending on their structure and composition...
ty molecule in most organisms. It has been associated with
atherosclerosisAtherosclerosis is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol...
, even in the absence of
hypercholesterolemiaHypercholesterolemia is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease...
(high
cholesterolCholesterol is a lipidic, waxy steroid found in the cell membranes and transported in the blood plasma of all animals. It is an essential component of mammalian cell membranes, where it is required to establish proper membrane permeability and fluidity...
levels). It can also lead to
pancreatitisPancreatitis is inflammation of the pancreas that can occur in two very different forms. Acute pancreatitis is sudden while chronic pancreatitis "is characterized by recurring or persistent abdominal pain with or without steatorrhea or diabetes mellitus."...
in excessive concentrations. Very high triglyceride levels may also interfere with
blood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
s;
hyponatremiaHyponatremia is an electrolyte disturbance in which the sodium concentration in the plasma is lower than normal .Severe or rapidly progressing hyponatremia can result in swelling of the brain , and the symptoms of...
may be reported spuriously (
pseudohyponatremia).
A related term is "hyperglyceridemia" or "hyperglyceridaemia", which refers to a high level of all
glycerideGlycerides, more correctly known as acylglycerols, are esters formed from glycerol and fatty acids.Glycerol has three hydroxyl functional groups, which can be esterified with one, two, or three fatty acids to form monoglycerides, diglycerides, and triglycerides.Vegetable oils and animal fats...
s, including monoglycerides, diglycerides and triglycerides.
Modestly elevated triglyceride levels do not lead to any physical symptoms. Higher levels are associated with lipemia retinalis (white appearance of the
retinaThe vertebrate retina is a light sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...
), eruptive
xanthomaA xanthoma is a deposition of yellowish cholesterol-rich material in tendons and other body parts in various disease states.- External links :...
s (small lumps in the skin, sometimes itchy).
- Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind."...
(constitutional)
- Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
- High sugar
Sugar is a class of edible crystalline substances, mainly sucrose, lactose, and fructose. Human taste buds interpret its flavor as sweet. Sugar as a basic food carbohydrate primarily comes from sugar cane and from sugar beet, but also appears in fruit, honey, sorghum, sugar maple , and in many...
diet
- Diabetes mellitus
Diabetes mellitus —often referred to simply as diabetes—is a condition in which the body either does not produce enough, or does not properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy...
and insulin resistanceInsulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. Insulin resistance in fat cells reduces the effects of insulin and results in elevated hydrolysis of stored triglycerides in the absence of...
- it is one of the defined components of metabolic syndromeMetabolic syndrome is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. It affects one in five people, and prevalence increases with age...
(along with central obesityAbdominal obesity, colloquially known as belly fat or clinically as central obesity, is the accumulation of visceral fat resulting in an increase in waist size...
, hypertensionHypertension is a chronic medical condition in which the blood pressure is elevated. It is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word "hypertension", by itself, normally refers to systemic, arterial hypertension.Hypertension can be classified as either...
, and hyperglycemiaHyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood glucose level of 10+ mmol/L , but symptoms may not start to become noticeable until later numbers such as 15-20+ mmol/L or...
)
- Excess alcohol
An alcoholic beverage is a drink that contains ethanol . Alcoholic beverages are divided into three general classes: beers, wines, and spirits....
intake
- Nephrotic syndrome
Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine....
- Genetic predisposition
- Certain medications (e.g., isotretinoin
Isotretinoin is a medication used for the treatment of moderate to severe acne. It was first developed to be used as a chemotherapy medication for the treatment of brain cancer, pancreatic cancer and more. It is still used in the treatment of these cancers to this day because of its ability to...
)
- Hypothyroidism
Hypothyroidism is the disease state in humans and in animals caused by insufficient production of thyroid hormone by the thyroid gland. Cretinism is a form of hypothyroidism found in infants.-Causes:...
(underactive thyroid)
Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the
dietIn nutrition, the diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. Although humans are omnivores, each culture holds some food preferences and some food taboos. Individual...
, as well as with
niacinNiacin, also known as vitamin B
3 or nicotinic acid, is a water-soluble vitamin. It is an organic compound with the molecular formula C
6H
5NO
2. It is a derivative of pyridine, with a carboxyl group at the 3-position...
,
fibrateIn pharmacology, the fibrates are a class of amphipathic carboxylic acids. They are used for a range of metabolic disorders, mainly hypercholesterolemia , and are therefore hypolipidemic agents.- Members :...
s and
statinThe statins are a class of drugs that lower cholesterol levels in people with or at risk of cardiovascular disease...
s (three classes of drugs).
In
medicineMedicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
,
hypertriglyceridemia (or "Hypertriglyceridaemia") denotes high (
hyper-) blood levels (
-emia) of
triglycerideis a glyceride in which the glycerol is esterified with three fatty acids. It is the main constituent of vegetable oil and animal fats.- Chemical structure :...
s, the most abundant
fatFats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water. Chemically, fats are generally triesters of glycerol and fatty acids. Fats may be either solid or liquid at normal room temperature, depending on their structure and composition...
ty molecule in most organisms. It has been associated with
atherosclerosisAtherosclerosis is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol...
, even in the absence of
hypercholesterolemiaHypercholesterolemia is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease...
(high
cholesterolCholesterol is a lipidic, waxy steroid found in the cell membranes and transported in the blood plasma of all animals. It is an essential component of mammalian cell membranes, where it is required to establish proper membrane permeability and fluidity...
levels). It can also lead to
pancreatitisPancreatitis is inflammation of the pancreas that can occur in two very different forms. Acute pancreatitis is sudden while chronic pancreatitis "is characterized by recurring or persistent abdominal pain with or without steatorrhea or diabetes mellitus."...
in excessive concentrations. Very high triglyceride levels may also interfere with
blood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
s;
hyponatremiaHyponatremia is an electrolyte disturbance in which the sodium concentration in the plasma is lower than normal .Severe or rapidly progressing hyponatremia can result in swelling of the brain , and the symptoms of...
may be reported spuriously (
pseudohyponatremia).
A related term is "hyperglyceridemia" or "hyperglyceridaemia", which refers to a high level of all
glycerideGlycerides, more correctly known as acylglycerols, are esters formed from glycerol and fatty acids.Glycerol has three hydroxyl functional groups, which can be esterified with one, two, or three fatty acids to form monoglycerides, diglycerides, and triglycerides.Vegetable oils and animal fats...
s, including monoglycerides, diglycerides and triglycerides.
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
retinaThe vertebrate retina is a light sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...
), eruptive
xanthomaA xanthoma is a deposition of yellowish cholesterol-rich material in tendons and other body parts in various disease states.- External links :...
s (small lumps in the skin, sometimes itchy).
Causes
- Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind."...
(constitutional)
- Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
- High sugar
Sugar is a class of edible crystalline substances, mainly sucrose, lactose, and fructose. Human taste buds interpret its flavor as sweet. Sugar as a basic food carbohydrate primarily comes from sugar cane and from sugar beet, but also appears in fruit, honey, sorghum, sugar maple , and in many...
diet
- Diabetes mellitus
Diabetes mellitus —often referred to simply as diabetes—is a condition in which the body either does not produce enough, or does not properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy...
and insulin resistanceInsulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. Insulin resistance in fat cells reduces the effects of insulin and results in elevated hydrolysis of stored triglycerides in the absence of...
- it is one of the defined components of metabolic syndromeMetabolic syndrome is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. It affects one in five people, and prevalence increases with age...
(along with central obesityAbdominal obesity, colloquially known as belly fat or clinically as central obesity, is the accumulation of visceral fat resulting in an increase in waist size...
, hypertensionHypertension is a chronic medical condition in which the blood pressure is elevated. It is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word "hypertension", by itself, normally refers to systemic, arterial hypertension.Hypertension can be classified as either...
, and hyperglycemiaHyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood glucose level of 10+ mmol/L , but symptoms may not start to become noticeable until later numbers such as 15-20+ mmol/L or...
)
- Excess alcohol
An alcoholic beverage is a drink that contains ethanol . Alcoholic beverages are divided into three general classes: beers, wines, and spirits....
intake
- Nephrotic syndrome
Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine....
- Genetic predisposition
- Certain medications (e.g., isotretinoin
Isotretinoin is a medication used for the treatment of moderate to severe acne. It was first developed to be used as a chemotherapy medication for the treatment of brain cancer, pancreatic cancer and more. It is still used in the treatment of these cancers to this day because of its ability to...
)
- Hypothyroidism
Hypothyroidism is the disease state in humans and in animals caused by insufficient production of thyroid hormone by the thyroid gland. Cretinism is a form of hypothyroidism found in infants.-Causes:...
(underactive thyroid)
Treatment
Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the
dietIn nutrition, the diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. Although humans are omnivores, each culture holds some food preferences and some food taboos. Individual...
, as well as with
niacinNiacin, also known as vitamin B
3 or nicotinic acid, is a water-soluble vitamin. It is an organic compound with the molecular formula C
6H
5NO
2. It is a derivative of pyridine, with a carboxyl group at the 3-position...
,
fibrateIn pharmacology, the fibrates are a class of amphipathic carboxylic acids. They are used for a range of metabolic disorders, mainly hypercholesterolemia , and are therefore hypolipidemic agents.- Members :...
s and
statinThe statins are a class of drugs that lower cholesterol levels in people with or at risk of cardiovascular disease...
s (three classes of drugs). Increased
fish oilFish oil is oil derived from the tissues of oily fish. It is recommended for a healthy diet because it contains the omega-3 fatty acids, eicosapentaenoic acid , and docosahexaenoic acid , precursors to eicosanoids that reduce inflammation throughout the body...
intake may substantially lower an individual's triglycerides.
Clinical practice guidelines by the
National Cholesterol Education ProgramThe National Cholesterol Education Program is a program managed by the National Heart, Lung and Blood Institute, a division of the National Institutes of Health. Its goal is to reduce increased cardiovascular disease rates due to hypercholesterolemia in the United States of America...
(NCEP) suggests that pharmacotherapy be considered with a triglycerides level over 200 mg/dL. 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."
Non–HDL cholesterol contains the highly atherogenic, small, dense lipoproteins that are associated with a high incidence of cardiovascular disease (CVD). Studies subsequent to the NCEP report have shown that the non–HDL cholesterol level predicts CVD in people who have diabetes. It may be superior to LDL cholesterol in this regard, and should be used as the primary lipid target in persons with diabetes.
Primary prevention
Omega-3 fatty acid supplementation in the form of fish oil has been found to be effective in decreasing levels of triglycerides and thus all cardiovascular events by 19% to 45%.
GemfibrozilGemfibrozil is the generic name for an oral drug used to lower lipid levels. It belongs to a group of drugs known as fibrates. It is most commonly sold as the brand name, Lopid...
twice daily in asymptomatic men ages 40–55 without heart disease was also found to be effective at reducing cardiac endpoints at 5 years (4.14% to 2.73%). This means that 54 people must take the treatment for five years to prevent one cardiac event (
number needed to treatThe number needed to treat is an epidemiological measure used in assessing the effectiveness of a health-care intervention, typically a treatment with medication. The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome...
of 54).
Secondary prevention
A
randomized controlled trialA randomized controlled trial is a type of scientific experiment most commonly used in testing the efficacy or effectiveness of healthcare services or health technologies . RCTs are also employed in other research areas, such as judicial, educational, and social research...
of men with known heart disease and HDL cholesterol of 40 mg/dl or less , 600 mg of gemfibrozil twice daily reduced cardiac endpoints (non-fatal 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 treatThe number needed to treat is an epidemiological measure used in assessing the effectiveness of a health-care intervention, typically a treatment with medication. The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome...
is 23).