Treatment options for severe hypertriglyceridemia (SHTG): the role of apheresis

Nils Ewald,Hans-Ulrich Kloer

doi:10.1007/s11789-012-0042-x

Nils Ewald, Hans-Ulrich Kloer

Open Access

https://doi.org/10.1007/s11789-012-0042-x

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Abstract

Hypertriglyceridemia is associated with a number of severe diseases such as acute pancreatitis and coronary artery disease. In severe hypertriglyceridemia (SHTG, triglycerides > 1,000 mg/dL), rapid lowering of plasma triglycerides (TG) has to be achieved. Treatment regimes include nutritional intervention, the use of antihyperlipidemic drugs, and therapeutic apheresis. Apheretic treatment is indicated in medical emergencies such as hypertriglyceridemic pancreatitis.Reviewing the current literature, plasmapheresis appears to be a safe and useful therapeutic tool in patients suffering from SHTG. Apheretic treatment is able to remove the causative agent for pancreatic inflammation. Data suggests that the use of apheresis should be performed as early as possible in order to achieve best results. The use of plasmapheresis, however, is limited due to the rather high costs and the limited availability of the procedure.

Highlights

Severe hypertriglyceridemia (SHTG) is well known to be associated with severe diseases such as acute pancreatitis and cardiovascular disease.Concerning the role of triglycerides (TG) in promoting cardiovascular disease, there are still controversial discus-The role of SHTG in causing acute pancreatitis, is commonly accepted
Plasmapheresis appears to be a safe and useful therapeutic tool in patients suffering from SHTG
Data suggests that the use of apheresis should be performed as early as possible in order to achieve best results

Summary

Introduction

Severe hypertriglyceridemia (SHTG) is well known to be associated with severe diseases such as acute pancreatitis and cardiovascular disease. Since patients with excessively elevated TG levels are in urgent need of a fast and effective lowering of their TG levels in order to prevent a severe pancreatitis episode, further measures must be taken. Immediate apheretic treatment might be an interesting option in order to rapidly lower excessively elevated TG levels and prevent or attenuate acute pancreatitis in these patients. Heparin treatment in SHTG is subject to greater controversy due to the only transient rise in LPL followed by increased degradation and depletion of plasma stores resulting in LPL deficiency [23,24,25] Another treatment modality potentially useful for cases of SHTG with documented LPL deficiencies is described by Stroes et al [26].

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