Summary of Recommendations

1.0 Diagnosis and Definitions

1.1. Severe and very severe hypertriglyceridemia increase the risk for pancreatitis while mildor moderate hypertriglyceridemia may be a risk factor for cardiovascular disease. Therefore,similar to the NCEP ATP III guideline committee’s recommendations, we recommendscreening adults for hypertriglyceridemia as part of a lipid panel at least every 5 years.

1.2. We recommend basing the diagnosis of hypertriglyceridemia on fasting triglyceride levels and not on nonfasting triglyceride levels.

1.3. We recommend against the routine measurement of lipoprotein particle heterogeneity in patients with hypertriglyceridemia. We suggest that measurement of apoB or Lp(a) levels can be of value, while measurement of other apolipoprotein levels has little clinical value.

2.0 Causes of Elevated Triglycerides Primary and Secondary

2.1. We recommend that individuals found to have any elevation of fasting triglycerides should beevaluated for secondary causes of hyperlipidemia including endocrine conditions andmedications. Treatment should be focused on such secondary causes.

2.2. We recommend that patients with primary hypertriglyceridemia be assessed for other cardiovascular risk factors, such as central obesity, hypertension, abnormalities of glucose metabolism, and liver dysfunction.

2.3. We recommend that clinicians evaluate patients with primary hypertriglyceridemia for family history of dyslipidemia and cardiovascular disease to assess genetic causes and future cardiovascular risk.

3.0 Management of Hypertriglyceridemia

3.1. We recommend lifestyle therapy, including dietary counseling to 111 achieve appropriate diet composition, physical activity, and a program to achieve weight reduction in overweight and obese individuals as the initial treatment of mild-to-moderate hypertriglyceridemia.

3.2. For severe and very severe hypertriglyceridemia (>1,000 mg/dl), we recommend combining reduction of dietary fat and simple carbohydrate intake with drug treatment to reduce the risk of pancreatitis.

3.3. We recommend that the treatment goal for patients with moderate hypertriglyceridemia be a non-HDL cholesterol level in agreement with NCEP-ATP guidelines.

3.4. We recommend that a fibrate be used as a first-line agent for reduction of triglycerides in patients at risk for triglyceride-induced pancreatitis.

3.5. We suggest that three drug classes (fibrates, niacin, n-3 fatty acids) alone or in combination with statins be considered as treatment options in patients with moderate to severe triglyceride levels.

3.6. We recommend that statins not be used as monotherapy for severe or very severehypertriglyceridemia. However, statins may be useful for the treatment of moderate hypertriglyceridemia when indicated to modify cardiovascular risk.

SOURCE: Berglund L, Brunzell J, Goldberg A, et al.  Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:2969-2989.