Severe hypertriglyceridemia with a history of treatment failure

Division of Endocrinology, Metabolism, and Diabetes at the University of Colorado at Denver and Health Sciences Center, CO, USA.
Nature Reviews Endocrinology (Impact Factor: 13.28). 10/2005; 1(1):53-58. DOI: 10.1038/ncpendmet0025


Background A 53-year-old man with a history of hypertension and gout was referred to our clinic for severe hypertriglyceridemia, diagnosed 3 years previously. He was asymptomatic and had no history of abdominal pain, pancreatitis or diabetes, but consumed six cans of beer per night. Over the previous 2 years, he had been treated unsuccessfully with multiple medications; during this period his fasting triglycerides ranged from 5.41 mM to 55.04 mM (479 to 4,871 mg/dl).
Investigations Physical examination including fundoscopy, medication review, and laboratory tests.
Diagnosis Severe hypertriglyceridemia due to a genetic combined hyperlipidemia, exacerbated by persistent excessive alcohol intake and metabolic syndrome.
Management Cessation of alcohol intake, initiation of a fat-restricted diet, and fibrate therapy, with close follow-up. Once serum triglycerides were controlled, attention was turned to lowering LDL-cholesterol concentration according to The National Cholesterol Education Program, Adult Treatment Panel III guidelines.

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    • "Most cases of pancreatitis were found in the highest quartiles of TG levels (>15.9 mmol/l (1415 mg/dl)), suggesting that values up to 15.9 mmol/l in the absence of alcohol abuse are not a major risk factor for the development of pancreatitis. The prevalence of severe HT in the general population is not well known (Capell and Eckel, 2005; Valdivielso et al., 2009). The ICARIA study, a large study regarding prevalence and risk factors of HT in an active Spanish working population, reports a prevalence of 1 in 3000 for severe HT (TG > 11.28 mmol/l; Valdivielso et al., 2009). "
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    ABSTRACT: This study was conducted to examine the relationship between triglyceride (TG) levels and a history of excessive drinking in patients with severe hypertriglyceridemia (HT). Alcohol intake as well as other risk factors associated with HT were searched for in case records of 300 patients known to the laboratory to have had a TG level over 11.3 mmol/l. The majority of severe HT could be attributed to obesity, diabetes mellitus, excessive alcohol consumption or combinations of these. Excessive alcohol intake (over 210 g/week for males; over 140 g/week for females) was recorded for 24% of the total, and for 43% in the highest TG quartile. TG levels were significantly higher in the excessive drinkers (P < 0.001) and in patients with acute pancreatitis (P = 0.001). The incidence of pancreatitis in this cohort was 4% and limited to very high TG levels. Excessive alcohol consumption was recorded in a quarter of patients with severe HT. Patients with the combination of obesity, diabetes and alcohol excess are prone to develop extremely high TG values.
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    ABSTRACT: Hypertriglyceridemia is a disorder commonly encountered in clinical practice. Treatment of this condition aims to prevent the major complications of hypertriglyceridemia, which differ depending on whether triglyceride elevations are moderate or severe. This review discusses the pathophysiology and clinical consequences of hypertriglyceridemia and outlines treatment approaches based on the degree of triglyceride elevation. Special consideration is given to clinical trials using medications that primarily target triglycerides.
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