Hypertriglyceridemia: Pathophysiology, Diagnosis, and Treatment

The hypertriglyceridemias are a family of common metabolic disorders that are associated with two potentially life-threatening complications: pancreatitis and atherosclerosis. Hypertriglyceridemia is caused by overproduction and/or impaired clearance of the triglyceride-rich lipoproteins (chylomicrons, very low-density lipoproteins, and intermediate-density lipoproteins). The most common forms of hypertriglyceridemia are secondary to underlying environmental or metabolic abnormalities, but several primary causes have been identified. A successful approach to the diagnosis of these disorders requires a careful history and physical examination, quantitative measurements of lipid and lipoprotein levels in plasma after an overnight fast, a thorough search for secondary causes of hyperlipidemia, and a detailed assessment of the family history. In most patients, the initial treatment of hypertriglyceridemia should employ hygienic measures including diet modification, exercise, smoking cessation, and weight loss. The guidelines for drug treatment remain indistinct, but the current consensus indicates that lipid-lowering medications are warranted if the triglyceride level remains greater than 500 mg/dL.