Severe hypertriglyceridemia is a very severe form of hypertriglyceridemia - one of the dyslipidemias. What are the causes and symptoms of severe hypertriglyceridaemia? What complications are patients with severe hypertriglyceridemia at risk of?
Severe hypertriglyceridemiais a separate disease - we recognize it if the triacylglycerol concentration is at least 500 mg / dl or 5.6 mmol / l.
Severe hypertriglyceridemia is not always hereditary, but often presents as familial hypercholesterolaemia. It usually has a genetic background and, as the name suggests, it runs in families, there are 5 types.
The most common are: type V and type I hyperlipoproteinemia, the first of which is the result of genetic susceptibility and various diseases (obesity, diabetes or hypothyroidism) or drinking alcohol. On the other hand, type V, i.e. familial chylomicronemia syndrome, is exclusively genetically determined.
It is worth remembering that not all severe hypertriglyceridemia is familial, although it is believed that with such high triglyceride values there is often a genetic predisposition to which environmental factors overlap:
- smoking
- lack of physical activity
- bad diet
It is then said about the so-called primary hypertriglyceridemia, i.e. without any specific basis. However, before such a diagnosis is made, it is necessary to look for the causes of such high concentrations of triglycerides - endocrine diseases or pharmacotherapy.
Interestingly, not all types of familial hypercholesterolaemia are associated with an increased risk of cardiovascular disease because if chylomicrons (another form of blood lipid transport) are present in the plasma in the course of this disease, they are too large to penetrate to the vessel wall and contribute to the development of atherosclerosis.
It should be remembered, however, that other risk factors for atherosclerosis and cardiovascular disease may coexist with familial hypertriglyceridemia.
Some authors distinguish the so-called very severe hypertriglyceridemia, in which the triglyceride concentration values exceed 2000 mg / dl (22.4 mmol / l), it is of such clinical significance that at such high values the risk of the complications described below is higher, and treatment mustbe more intense.
Hypertriglyceridemia: symptoms
Hypertriglyceridaemia may be asymptomatic and the diagnosis is made haphazardly during routine lipid screening.
Remember that if LDL cholesterol levels rise and HDL levels fall in severe hypertriglyceridemia, the risk of cardiovascular disease increases significantly.
As mentioned in typical familial hypercholesterolaemia, the risk remains at the level similar to that in people who do not have this disease due to normal HDL and LDL levels.
- HDL and LDL - standards
Sometimes severe hypertriglyceridemia is only detected when complications occur, such as acute pancreatitis, and the cause of its occurrence is investigated, in the presence of such a complication, triglyceride levels are usually above 1000 mg / dL or 11.3 mmol / L.
The aforementioned acute pancreatitis is manifested by sudden, very severe abdominal pain, in addition to vomiting, it is a serious disease that often has very serious complications.
In the absence of complications, the main symptom of severe hypertriglyceridemia may be abdominal pain and, of course, the above-mentioned elevated blood triglycerides, often accompanied by high total cholesterol and low LDL cholesterol values.
Yellow tufts are another characteristic symptom of excess blood lipids, they are a symptom of the accumulation of excess fat in the skin, most often around the eyelids and tendons. The tufts are yellow in color and can be small bumps or spots.
Depending on the type of hypertriglyceridaemia, liver enlargement may also occur due to lipid deposition or increased lipid metabolism.
In the diagnosis of severe hypertriglyceridemia, apart from determining the fasting lipid profile in the blood serum, the so-called cold flotation test is also important, which consists in assessing the serum after leaving it overnight at a low temperature, in the presence of chylomicrons on the surface, above serum, a milky layer of lipids is formed.
If this serum is clear, we are dealing with type I hyperlipoproteinemia, and if cloudy with type V hypolipoproteinemia. It is worth remembering that in families with genetically determined hypercholesterolaemia, the lipidogram should be monitored from the age of 2.
It happens that severe hypertriglyceridemia is accompanied by other disorders of lipid metabolism: hyperlipidemia and hypercholesterolaemia.
Hypertriglyceridemia: treatment
Unfortunately, the reasons for family variantsHypertriglyceridemia cannot be completely cured and the therapy is chronic.
The management of family variants and primary severe hypertriglyceridaemia is similar. However, it should be remembered that the most important goal of therapy is to prevent the occurrence of acute pancreatitis, as well as to reduce the risk of cardiovascular diseases.
The basis is a change in lifestyle, implementing an appropriate diet with a very low content of fats and simple sugars, which our body easily converts into lipids. In addition, you should minimize the amount of alcohol you drink.
In the field of pharmacotherapy, drugs that lower blood lipids are used - the so-called fibrates and statins, it is also important to consume omega-3 polyunsaturated fatty acids, which are contained in fish oils, they can also be supplemented in the form of capsules .
Pharmacotherapy is implemented in various ways, because each of these preparations has a different mechanism of action and reduces different cholesterol fractions. Depending on the current main goal of treating severe hypertriglyceridaemia, your doctor will recommend appropriate medications.
The above-mentioned recommendations regarding diet and pharmacotherapy are used in most cases of hypertriglyceridemia (not only family and severe), so the correction of incorrect cholesterol values requires:
- weight reduction in overweight and obese people
- proper diet
- eat meals regularly
- physical activity
- stop smoking and drinking alcohol
These actions are no less effective than pharmacotherapy, which is started only when non-pharmacological actions fail, of course, even in combination with tablet treatment, it is necessary to continue adhering to dietary and physical activity recommendations.
Adequate treatment of comorbidities, especially diabetes, and the appropriate selection of drugs are also important, as e.g. glucocorticosteroids, used, for example, in rheumatological diseases, have a very negative effect on the lipid metabolism, causing an increase in the cholesterol value .
During the treatment of hypertriglyceridemia, lipid profile checks are necessary, initially every 6 weeks, then less frequently, even every 2 years, if the therapy is effective.
Severe hypertriglyceridemia is a disease that is a metabolic disorder, it causes the appearance of an increased amount of fat in the blood, increases the level of triglycerides, and therefore increases the risk of acute pancreatitis and the development of heart disease.
In the treatment of severe hypertriglyceridaemia, appropriate pharmacological treatment combined with non-pharmacological effects is very important. Unfortunately, the therapy is chronic, but necessary due to the risk of serious complications.
Triglycerics
Triglycerides (actually triacylglycerols or triglycerides) are chemically lipid compounds of glycerol bound by an ester bond to three long chain fatty acids (e.g. eicosapentaenoic acid).
Depending on whether they are the same or different acids, we are talking about simple or complex triacylglycerols.
They have different properties depending on their composition and spatial configuration. They perform various functions in the human body, primarily energetic - both for current needs and in the form of reserve material in adipose tissue, but their task is also, for example, to build cell membranes.
Triglycerides are also one of the forms of transport of lipids in the blood, thanks to which we can check their amount in our body in a simple laboratory test. Testing of triglycerides concentration is, in addition to HDL cholesterol, LDL cholesterol and total cholesterol, part of the so-called lipid profile.
The standard of their value is below 1.7mmol / l or below 150mg / dl. Increased triglyceride levels (hypertriglyceridemia) may accompany several diseases: diabetes, metabolic syndrome, hypothyroidism or kidney failure.
Unfortunately, triglycerides above the norm are an important risk factor for cardiovascular diseases, including myocardial infarction, especially if we are dealing with the so-called atherogenic dyslipidemia, in which hypertriglyceridemia is accompanied by: low HDL concentration and so-called low dense LDL.
About the author
Bow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).