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Hypertriglyceridaemia: an update
  1. Anthony S Wierzbicki1,
  2. Eun Ji Kim1,
  3. Oluwayemisi Esan1,
  4. Radha Ramachandran2
  1. 1Chemical Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. 2Metabolic Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Anthony S Wierzbicki, Chemical Pathology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK; anthony.wierzbicki{at}kcl.ac.uk

Abstract

Triglycerides (TGs) form part of the standard lipid profile. Elevations in TGs are associated with increased cardiovascular disease risk through triglyceride-rich lipoprotein particles found as part of non-HDL cholesterol. Many elevations of TGs are secondary to other causes, but primary hypertriglyceridaemia syndromes need to be identified. The genetic causes of hypertriglyceridaemia range from familial combined hyperlipidaemia through the autosomal recessive remnant hyperlipidaemia (related to apolipoprotein E variants) and familial chylomicronaemia syndromes. Patients with primary hypertriglyceridaemia >10 mmol/L require characterisation and specific intervention. Simple lipid profiles do not provide adequate information for detailed diagnosis and additional assays such as apolipoprotein (apo)B100, apoE genotype and next-generation sequencing may be useful. Management of raised TGs includes optimising diet, reducing exacerbating factors as well as lipid-lowering medications such as statins, fibrates, niacin and omega-3 fatty acids. Novel medications for orphan disease indications such as familial chylomicronaemia syndrome include volanesorsen, evinacumab and other antisense therapeutics. Extreme hypertriglyceridaemia syndromes, especially chylomicronaemia syndromes, which can be exposed by pregnancy or other factors are a medical emergency and require admission and specialist management sometimes including plasma exchange.

  • chemistry, clinical
  • diagnostic techniques and procedures
  • cardiovascular diseases
  • lipids
  • lipoproteins

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Footnotes

  • Handling editor Patrick J Twomey.

  • Contributors ASW wrote the initial draft of the manuscript. EJK, OE and RR revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ASW is a site clinical investigator for clinical trials of drugs in management of familial chylomicronaemia syndrome and high triglycerides including Akcea (volanesorsen; apoC3LRx), Arrowhead (Aro-apoC3) and Regeneron (evinacumab).

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.