Endocrine Society issues Hypertriglyceridemia Guidelines

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  • The Endocrine Society Guideline for the assessment of patients with hypertriglyceridemia recommends that the diagnosis be based on fasting triglyceride levels.
  • At least every 5 years, adults should be screened for hypertriglyceridemia as part of a lipid panel.
  • To facilitate assessment of cardiovascular risk, mild and moderate hypertriglyceridemia, defined as triglyceride levels of 150 to 999 mg/dL, should be diagnosed, as this condition may be a risk factor for cardiovascular disease.
  • Patients with severe and very severe hypertriglyceridemia, defined as triglyceride levels of more than 1000 mg/dL, should be considered to be at risk for pancreatitis.
  • Patients with hypertriglyceridemia should undergo evaluation for secondary causes of hyperlipidemia, such as endocrine conditions and medications, and treatment should be focused on such secondary causes.
  • Patients with primary hypertriglyceridemia should be assessed for a family history of dyslipidemia and cardiovascular disease, as well as for other cardiovascular risk factors including central obesity, hypertension, abnormalities of glucose metabolism, and liver dysfunction.
  • For patients with moderate hypertriglyceridemia, the treatment goal should be a non–high-density lipoprotein cholesterol level in agreement with NCEP-ATP guidelines.
  • For patients with mild to moderate hypertriglyceridemia, first-line therapy should be lifestyle interventions including physical activity. A combination of diet modification and pharmacotherapy may also be considered.
  • For patients with moderate to severe hypertriglyceridemia, treatment with fibrates, niacin, and/or omega-3 fatty acids alone or in combination with statins should be considered.
  • A fibrate should be used as a first-line agent in patients with severe or very severe hypertriglyceridemia, in addition to reduction of dietary fat and simple carbohydrate intake.
  • Statins should not be used as monotherapy for severe or very severe hypertriglyceridemia, but they may be useful for the treatment of moderate hypertriglyceridemia when indicated to modify cardiovascular risk.