The Endocrine Society today issued a Clinical Practice Guideline (CPG) for the diagnosis and treatment of hypertriglyceridemia. Triglycerides are a type of fat found in the blood and are associated with cardiovascular risk. The CPG, entitled “Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline” appears in the September 2012 issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of The Endocrine Society.
The most common reasons for high triglycerides include being overweight, lack of exercise, the metabolic syndrome, type 2 diabetes, and familial combined hyperlipidemia, a genetic disorder that runs in the family. It results in high triglycerides, high “bad” (low-density lipoprotein, or LDL) cholesterol and low “good” (high-density lipoprotein, or HDL) cholesterol.
“There is increasing evidence that high triglyceride levels represent a cardiovascular risk and in addition, very high triglyceride level is a risk factor for pancreatitis,” said Lars Berglund, MD, PhD, of the University of California, Davis, and chair of the task force that authored the guideline. “The guideline presents recommendations for diagnosis of high triglyceride levels, and recommendations for management and treatment.”
Recommendations from the CPG include:
- Because severe hypertriglyceridemia increases the risk for pancreatitis and mild hypertriglyceridemia may be a risk factor for cardiovascular disease, adults should be screened for hypertriglyceridemia as part of a lipid panel at least every five years;
- Diagnosis of hypertriglyceridemia should be based on fasting triglyceride levels and not on non-fasting triglyceride levels;
- • Individuals found to have any elevation of fasting triglycerides should be evaluated for secondary causes of hyperlipidemia including endocrine conditions and medications. Treatment should be focused on such secondary causes;
- Patients with primary hypertriglyceridemia should be assessed for other cardiovascular risk factors, such as central obesity, hypertension, abnormalities of glucose metabolism, and liver dysfunction;
- Clinicians should evaluate patients with primary hypertriglyceridemia for family history of dyslipidemia and cardiovascular disease to assess genetic causes and future cardiovascular risk; and
- Initial treatment of mild-to-moderate hypertriglyceridemia should be lifestyle therapy, including dietary counseling to achieve appropriate diet compostion, physical activity, and a program to achieve weight reduction in overweight and obese individuals.
The Hormone Health Network has published a companion patient guide to this CPG. The patient guide, which can be found online at http://www.hormone.org/Resources/upload/PG-Hypertriglyceridemia-web.pdf, explains how hypertriglyceridemia impacts the body and discusses treatment options.
Other members of The Endocrine Society task force that developed this CPG include: John D. Brunzell of the University of Washington; Anne C. Goldberg of Washington University School of Medicine; Ira J. Goldberg of Columbia University in New York; Frank Sacks of Harvard University School of Public Health in Boston, MA; Mohammad Hassan Murad of The Mayo Clinic in Rochester, MN; and Anton F. H. Stalenhoef of Radboud University Nijmegen Medical Centre in The Netherlands.
The Society established the Clinical Practice Guideline (CPG) Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on scientific reviews of the literature in the development of CPG recommendations. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds.
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- L. Berglund, J. D. Brunzell, A. C. Goldberg, I. J. Goldberg, F. Sacks, M. H. Murad, A. F. H. Stalenhoef. Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 2012; 97 (9): 2969 DOI: 10.1210/jc.2011-3213