Hypertriglyceridaemia: contemporary management of a neglected cardiovascular risk factor.

Tina Z Khan,Mahmoud Barbir,Ulrike Schatz,Mahmoud Barbir,Mahmoud Barbir,Stefan R Bornstein

doi:10.21542/gcsp.2021.19

Abstract

Hypertriglyceridaemia represents one of the most prevalent lipid abnormalities, however it is often eclipsed by focus on LDL cholesterol and is frequently overlooked by clinicians, despite it being an important cardiovascular risk factor. For most patients, hypertriglyceridaemia arises from a combination of environmental factors and multiple genetic variations with small effects. Even in cases with apparent familial clustering of hypertriglyceridaemia, a monogenetic cause is rarely identified. Common secondary causes include obesity, uncontrolled diabetes, alcohol, and various commonly used drugs. Correction of these factors, along with lifestyle optimisation, should be prioritised prior to commencing medication. The goal of drug treatment is to reduce the risk of cardiovascular disease in those with moderate hypertriglyceridaemia and the risk of pancreatitis in those with severe hypertriglyceridaemia. Recent and ongoing trials demonstrate the important role of triglycerides (TG) in determining residual risk in patients with cardiovascular disease (CVD) already established on statin therapy. Novel and emerging data on omega-3 fatty acids (high-dose icosapent ethyl) and the selective PPAR modulator pemafibrate are eagerly awaited and may provide further clarity for clinicians in determining which patients will benefit from TG lowering and help inform clinical guidelines. There are numerous novel therapies on the horizon that reduce TG by decreasing the activity of proteins that inhibit lipoprotein lipase such as apolipoprotein C-III (including Volanesorsen which was recently approved in Germany) and ANGPTL 3/4 which may offer promise for the future.

Highlights

Hypertriglyceridaemia represents a common lipid disorder, uncertainty and debate remain regarding its prognostic significance and optimal modes of treatment
This study demonstrated that Familial chylomicronemia syndrome (FCS) patients presented with a significantly higher frequency of pancreatitis (60% vs. 6%), multiple pancreatitis (48% vs. 3%), abdominal pain (63% vs. 19%) and a lower frequency of metabolic disturbances than in the multifactorial chylomicronemia (MCM) group (p < 0.0001)[13]
Hypertriglyceridaemia represents one of the most prevalent lipid abnormalities with moderate hypertriglyceridaemia predisposing to cardiovascular disease (CVD), and severe hypertriglyceridaemia (≥10 mmol/L) predisposing to acute pancreatitis

Summary

INTRODUCTION

Hypertriglyceridaemia represents a common lipid disorder, uncertainty and debate remain regarding its prognostic significance and optimal modes of treatment. Dyslipidaemia, characterized by hypertriglyceridaemia and increased LDL cholesterol, is commonly associated with non-alcoholic fatty liver disease (NAFLD) and in turn, cardiovascular disease (CVD) is the most common cause of mortality in NAFLD patients. Familial hypertriglyceridaemia is a relatively common lipid disorder with moderate elevations in serum triglycerides (5–25 mmol/L) due to increased secretion of triglyceriderich VLDL particles. Familial (type III) dysbetalipoproteinemia is a rare condition strongly associated with premature cardiovascular disease, which involves a genetic predisposition combined with environmental factors causing its manifestation[17]. In cases where secondary factors increase the generation of triglycerides (e.g., obesity, excess calorie intake, excess alcohol consumption, estrogen) or decrease their clearance (e.g., hypothyroidism); the alternate pathways become overwhelmed, causing accumulation of remnants[3]

CURRENT GUIDELINES

Findings

CONCLUSIONS