Severe Hypertriglyceridemia in the Hospitalized Patient
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Hypertriglyceridemia (HTG) is prevalent and likely to increase multifold over the next few decades mostly due to the rising prevalence of obesity and diabetes mellitus (DM). One of the most untoward complications of severe HTG is acute pancreatitis (AP) requiring hospitalization for intensive treatment. The risk for AP is more clearly defined at triglyceride levels >1000 mg/dL. The prevention of HTG-associated AP requires a multifaceted approach with initiation of weight loss strategies, limiting fat and simple carbohydrates from diet, restriction of alcohol, control of secondary risk factors such as uncontrolled diabetes, discontinuation of offending medications as possible, and initiation of lipid-lowering medications. Pharmacologic options for very high TG include fibrates, niacin, and omega-3 polyunsaturated fatty acids (OM3FA), composed primarily of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). New agents that are not yet readily available, but have shown significant benefits, include the class of drugs known as the Apo CIII inhibitors. In patients with uncontrolled hyperglycemia, insulin with or without heparin can be very effective in the acute inpatient setting. In some studies, plasmapheresis has also been shown to be an effective modality for urgent lowering of TG levels.
KeywordsSevere hypertriglyceridemia Acute pancreatitis associated with hypertriglyceridemia Familial syndromes of hypertriglyceridemia Hypertriglyceridemia secondary to medications Treatment of hypertriglyceridemia Omega-3 fatty acids Fibrates Niacin Apo CIII inhibitors
OG was partially supported by NIDDK grant # P30-DK036836.
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