Recommendations for Severe Hypertriglyceridemia Treatment, are there New Strategies?
Theodosios D. Filippatos and Moses S. Elisaf
Affiliation: Department of Internal Medicine, School of Medicine, University of Ioannina, 45 110 Ioannina, Greece.
Keywords: Cardiovascular risk, fibrates, lipoprotein lipase, niacin, orlistat, omega-3, plasmapheresis, severe hypertriglyceridemia.
This review considers drug combinations and newer treatment strategies for patients with severe hypertriglyceridemia.
Hypertriglyceridemia is associated with an atherogenic metabolic profile and in most studies with increased
cardiovascular disease risk. Patients with severe hypertriglyceridemia also have increased incidence of pancreatitis. All
types of severe hypertriglyceridemia are associated with a reduction in lipoprotein lipase activity. Patients with severe
hypertriglyceridemia and abdominal pain or pancreatitis should be hospitalized and treated with hypolipidemic drugs and,
if needed, with insulin/dextrose infusion or therapeutic apheresis. Fibrates are the first-line treatment in patients with
severe hypertriglyceridemia. Omega-3 fatty acids and niacin are very useful drugs for patients with hypertriglyceridemia.
Statins in high doses exhibit a significant hypotriglyceridemic activity. Drugs that interfere with chylomicron production
such as orlistat are also useful for hypertriglyceridemic patients. In most patients with severe hypertriglyceridemia drug
combinations are needed to maintain an acceptable triglyceride concentration. Gene therapy is under development for
patients with known genetic abnormalities of triglyceride metabolism. Clinicians should be vigilant for the recognition
and prompt treatment of patients with severe hypertriglyceridemia aimed to avoid the serious complication of pancreatitis
and to reduce their cardiovascular risk.
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