New Guidelines for Treating, Screening Hypertriglyceridemia

The new recommendations come from a task-force chair led by Dr. Lars Berglund (University of California, Davis).

Individuals with high triglyceride levels should undergo further assessment of other cardiovascular risk factors, such as obesity, hypertension, abnormal glucose metabolism, and liver dysfunction.

In the review, the expert panel notes that while there is robust evidence supporting the association between LDL-cholesterol levels and cardiovascular disease, the association between triglyceride levels and cardiovascular disease is more uncertain. However, they recommend screening adults for high triglycerides as part of a fasting lipid panel.

In addition to these recommendations, Berglund and colleagues recommend that:

• The diagnosis of hypertriglyceridemia be made on fasting triglyceride levels and not nonfasting levels.
• Individuals with high fasting triglyceride levels be evaluated for secondary causes of hyperlipidemia, including endocrine conditions and medications, and that treatment be focused on secondary causes.
• Patients with primary hypertriglyceridemia be screened for other cardiovascular risk factors.
• Patients with primary hypertriglyceridemia be evaluated for a family history of dyslipidemia and cardiovascular disease in order to assess future cardiovascular risk.
• Obese and overweight patients with mild to moderate hypertriglyceridemia be treated with lifestyle therapy, including dietary counseling, and physical-activity programs to achieve weight reduction.
• Dietary fat and simple-carbohydrate consumption be reduced in combination with drug therapy to lower the risk of pancreatitis for patients with severe and very severe hypertriglyceridemia.
• The treatment goal for patients with mild hypertriglyceridemia be a non-HDL-cholesterol level in agreement with the National Cholesterol Education Panel Adult Treatment Panel(NCEP ATP III) guidelines.
• Fibrates be used as a first-line drug to reduce triglycerides in patients at risk of triglyceride-induced pancreatitis.
• Fibrates, niacin, or omega-3 fatty acids be used alone or in combination with statins in patients with moderate to severe hypertriglyceridemia.
• And finally, statins not be used as monotherapy in patients with severe or very severe hypertriglyceridemia, although statins can be used to modify the risk of cardiovascular disease.

"Severe and very severe hypertriglyceridemia increase the risk for pancreatitis, while mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease," according to the authors of the clinical-practice guidelines. "Therefore, similar to the NCEP ATP III guidelines committee's recommendations, we recommend screening adults for hypertriglyceridemia as part of a fasting lipid panel at least every five years."

Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2969.