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Hypertriglyceridemia denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. Elevated levels of triglycerides are associated with atherosclerosis, even in the absence of hypercholesterolemia (high cholesterol levels), and predispose to cardiovascular disease. Very high triglyceride levels also increase the risk of acute pancreatitis. Hypertriglyceridemia itself is usually symptomless, although high levels may be associated with skin lesions known as xanthomas.^[1]

The diagnosis is made on blood tests, often performed as part of screening. Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.^[1]

Weight loss and dietary modification may be effective in hypertriglyceridemia. The decision to treat hypertriglyceridemia with medication depends on the levels and on the presence of other risk factors for cardiovascular disease. Very high levels that would increase the risk of pancreatitis is treated with a drug from the fibrate class. Niacin and omega-3 fatty acids as well as drugs from the statin class may be used in conjunction, with statins being the main drug treatment for moderate hypertriglyceridemia where reduction of cardiovascular risk is required.^[1]

Signs and symptoms

Most people with elevated triglycerides experience no symptoms. Some forms of primary hypertriglyceridemia can lead to specific symptoms: both familial chylomicronemia and primary mixed hyperlipidemia include skin symptoms (eruptive xanthoma), eye abnormalities (lipemia retinalis), hepatosplenomegaly (enlargement of the liver and spleen), and neurological symptoms. Some experience attacks of abdominal pain that may be mild episodes of pancreatitis. Eruptive xanthomas are 2–5 mm papules, often with a red ring around them, that occur in clusters on the skin of the trunk, buttocks and extremities.^[2] Familial dysbetalipoproteinemia causes larger, tuberous xanthomas; these are red or orange and occur on the elbows and knees. Palmar crease xanthomas may also occur.^[1]^[2]

The diagnosis is made on blood tests, often performed as part of screening. Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.^[1]

Acute pancreatitis occurs in people whose triglyceride levels are above 1000 mg/dl (11.3 mmol/l).^[1]^[2]^[3] Hypertriglyceridemia is associated with 1–4% of all cases of pancreatitis. The symptoms are similar to pancreatitis secondary to other causes, although the presence of xanthomas or risk factors for hypertriglyceridemia may offer clues.^[3]

Causes

High carbohydrate diet^[4]^[5]^[6]
High fat diet^[7]
Idiopathic (constitutional)
Obesity
Diabetes mellitus and insulin resistance - it is one of the defined components of metabolic syndrome (along with central obesity, hypertension, and hyperglycemia)
Excess alcohol consumption
renal failure, Nephrotic syndrome
Genetic predisposition; some forms of familial hyperlipidemia such as familial combined hyperlipidemia i.e. Type II hyperlipidemia
Lipoprotein lipase deficiency - Deficiency of this water-soluble enzyme, that hydrolyzes triglycerides in lipoproteins, leads to elevated levels of triglycerides in the blood.
Lysosomal acid lipase deficiency or Cholesteryl ester storage disease
Certain medications e.g. isotretinoin, estrogen, hydrochlorothiazide diuretics, beta blockers, protease inhibitors
Hypothyroidism (underactive thyroid)
Systemic Lupus Erythematosus
Glycogen storage disease type 1.
Propofol
HIV medications

Treatment

Weight loss and dietary modification may be effective in hypertriglyceridemia. The decision to treat hypertriglyceridemia with medication depends on the levels and on the presence of other risk factors for cardiovascular disease. Very high levels that would increase the risk of pancreatitis is treated with a drug from the fibrate class. Niacin and omega-3 fatty acids as well as drugs from the statin class may be used in conjunction, with statins being the main drug treatment for moderate hypertriglyceridemia where reduction of cardiovascular risk is required.^[1]

For people with mildly or moderately high levels of triglycerides lifestyle changes are recommended.^[1] This may include restriction of carbohydrates and fat in the diet. Medications are recommended in those with high levels of triglycerides, with fibrates being recommended first.^[1]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Berglund L, Brunzell JD, Goldberg AC, et al. (September 2012). "Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline". J. Clin. Endocrinol. Metab. 97 (9): 2969–89. doi:10.1210/jc.2011-3213. PMC 3431581. PMID 22962670.
^ ^a ^b ^c Yuan G, Al-Shali KZ, Hegele RA (April 2007). "Hypertriglyceridemia: its etiology, effects and treatment". CMAJ 176 (8): 1113–20. doi:10.1503/cmaj.060963. PMC 1839776. PMID 17420495.
^ ^a ^b Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A (April 2009). "Hypertriglyceridemic pancreatitis: presentation and management". Am. J. Gastroenterol. 104 (4): 984–91. doi:10.1038/ajg.2009.27. PMID 19293788.
^ Silva, ME; Pupo, AA; Ursich, MJ (1987). "Effects of a high-carbohydrate diet on blood glucose, insulin and triglyceride levels in normal and obese subjects and in obese subjects with impaired glucose tolerance.". Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.] 20 (3-4): 339–50. PMID 3330460.
^ McCarty, MF (2004). "An elevation of triglycerides reflecting decreased triglyceride clearance may not be pathogenic -- relevance to high-carbohydrate diets.". Medical hypotheses 63 (6): 1065–73. doi:10.1016/j.mehy.2002.11.002. PMID 15504577.
^ Garg, A; Grundy, SM; Unger, RH (Oct 1992). "Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM.". Diabetes 41 (10): 1278–85. doi:10.2337/diabetes.41.10.1278. PMID 1397701.
^ Pejic RN, Lee DT (May–Jun 2006). "Hypertriglyceridemia". J Am Board Fam Med 19 (3): 310–6. doi:10.3122/jabfm.19.3.310. PMID 16672684.

UpToDate Contents

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1. 高トリグリセリド血症患者に対するアプローチ approach to the patient with hypertriglyceridemia
2. 高トリグリセリド血症による急性膵炎 hypertriglyceridemia induced acute pancreatitis
3. Dyslipidemia in children: Management
4. フィブラート系薬剤による脂質低下 lipid lowering with fibric acid derivatives
5. 食事または栄養補助食品による脂質低下 lipid lowering with diet or dietary supplements

English Journal

Increased association of coronary artery calcification in apparently healthy Korean adults with hypertriglyceridemic waist phenotype: The Kangbuk Samsung Health Study.

Moon BS1, Park HJ1, Lee MK1, Jeon WS1, Park SE1, Park CY1, Lee WY1, Oh KW1, Park SW1, Rhee EJ2.
International journal of cardiology.Int J Cardiol.2015 Sep 1;194:78-82. doi: 10.1016/j.ijcard.2015.05.104. Epub 2015 May 19.
BACKGROUND: Hypertriglyceridemic waist phenotype is a simple screening parameter to identify people at increased risk for cardiovascular disease. We evaluated whether hypertriglyceridemic waist (HTGW) phenotype increases the risk for coronary artery calcification (CAC) in apparently healthy Korean a
PMID 26011271

Supplementation with two probiotic strains, Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032, reduces fasting triglycerides and enhances apolipoprotein A-V levels in non-diabetic subjects with hypertriglyceridemia.

Ahn HY1, Kim M2, Chae JS2, Ahn YT3, Sim JH3, Choi ID3, Lee SH4, Lee JH5.
Atherosclerosis.Atherosclerosis.2015 Aug;241(2):649-56. doi: 10.1016/j.atherosclerosis.2015.06.030. Epub 2015 Jun 18.
OBJECTIVE: Previous studies have indicated that supplementation with probiotics might improve lipid metabolism. The objective of the study was to evaluate the effect of supplementation with probiotic strains Lactobacillus curvatus (L. curvatus) HY7601 and Lactobacillus plantarum (L. plantarum) KY1
PMID 26117402

Chlamydia pneumoniae acute liver infection affects hepatic cholesterol and triglyceride metabolism in mice.

Marangoni A1, Fiorino E2, Gilardi F2, Aldini R3, Scotti E2, Nardini P1, Foschi C1, Donati M1, Montagnani M4, Cevenini M4, Franco P5, Roda A5, Crestani M6, Cevenini R1.
Atherosclerosis.Atherosclerosis.2015 Aug;241(2):471-9. doi: 10.1016/j.atherosclerosis.2015.05.023. Epub 2015 Jun 3.
OBJECTIVE: Chlamydia pneumoniae has been linked to atherosclerosis, strictly associated with hyperlipidemia. The liver plays a central role in the regulation of lipid metabolism. Since in animal models C. pneumoniae can be found at hepatic level, this study aims to elucidate whether C. pneumoniae
PMID 26086356

Japanese Journal

症例報告分娩様式選択の判断に苦慮した高トリグリセライド血症を原因として急性膵炎を発症した妊娠症例 (平成26年度前期学術集会一般演題)

埼玉産科婦人科学会雑誌 = Saitama journal of obstetrics and gynecology 45(1), 3-7, 2015-03
NAID 40020418623

脂肪乳剤の血管弛緩および収縮機能に対する影響

山形大学紀要. 医学 : 山形医学 33(1), 1-8, 2015-02-15
NAID 110009889041

Genetic Diagnosis via Whole Exome Sequencing in Taiwanese Patients with Hypertriglyceridemia

Journal of Atherosclerosis and Thrombosis 22(9), 887-900, 2015
NAID 130005099302

Related Pictures

Hypertriglyceridemia – Anejo Common problems in the management of hypertriglyceridemia | CMAJ Familial hypertriglyceridemia. Causes, symptoms, treatment Familial hypertriglyceridemia Eruptive xanthomas in a patient with severe hypertriglyceridemia and type 2 diabetes Hypertriglyceridemia | NEJM Treating hypertriglyceridemia | CMAJ Hypertriglyceridemia: its etiology, effects and treatment | CMAJ Hypertriglyceridemia induced pancreatitis

★リンクテーブル★

リンク元	「脂質異常症」「高中性脂肪血症」「高トリグリセリド血症」「hypertriglyceridemic」「hypertriglyceridaemic」
拡張検索	「familial hypertriglyceridemia」
関連記事	「hypertriglyceridemias」

「脂質異常症」

Hypertriglyceridemia
	Triglyceride, which cause hypertriglyceridemia at high level
Classification and external resources
Specialty	endocrinology
ICD-10	E78.1, E78.2, E78.3
ICD-9-CM	272.1
OMIM	145750
DiseasesDB	6372
MedlinePlus	000397
eMedicine	med/2921 article/126568
MeSH	D015228

　　[★]

英: dyslipidemia
同: 高脂血症 hyperlipidemia、脂質代謝異常 lipoprotein disorders
関: 高脂血症治療薬、リポ蛋白

定義

血清：~~Total-CHO≧220 mg/dl~~。LDL-C≧140 mg/dl。TG≧150 mg/dl。HDL-C＜40 mg/dl

病型

原発性

家族性
特発性

二次性

分類

原発性高脂血症のWHO分類

型分類			増加するリポ蛋白	血清脂質の変動	コレステロール (mg/dl)	トリグリセリド (mg/dl)
正常			-	-	<220	<150
I型高脂血症	高カイロミクロン血症	hyperchylomicronemia	カイロミクロン	中性脂肪著明増加	<260	>1000
IIa型高脂血症	高コレステロール血症	hypercholesterolemia	LDL	コレステロール増加	>220	>150
IIb型高脂血症	複合型高脂血症	combined hyperlipidemia	LDL, VLDL	コレステロールと中性脂肪増加	>220	150-300
III型高脂血症	異常βリポ蛋白血症	dysbetalipoproteinemia	IDL	電気泳動でbroad β	350-500	350-500
IV型高脂血症	高トリグリセリド血症	hypertriglyceridemia	VLDL	中性脂肪増加	<240	200-1000
V型高脂血症	複合型高トリグリセリド血症	mixed hypertriglyceridemia	カイロミクロン, VLDL	中性脂肪著明増加	<300	>1000

原発性高脂血症の型分類 (臨床検査法提要第32版 p.533)

		I型	II型		III型	IV型	V型
		I型	IIa型	IIb型	III型	IV型	V型
		高カイロミクロン血症	高コレステロール血症	複合型高脂血症	異常βリポ蛋白血症	高トリグリセリド血症	複合型高トリグリセリド血症
増加リポ蛋白	CM	＋＋					＋
	VLDL			＋		＋	＋
	IDL				＋
	LDL		＋	＋
血漿脂質	TC	＋	＋＋＋	＋＋	＋＋	/＋	＋
	TG	＋＋＋		＋＋	＋＋	＋＋	＋＋＋
	TC/TG	＜0.2	＞1.6	不定	≒	0.6-1.6	＜0.6
病因		・LPL欠損・アポCII欠損 (外因性高脂血症)	LDL受容体異常	不明	アポE異常 (E2/E2など)	不明 (内因性高脂血症)	LPL欠損へテロ(一部) (外因性高脂血症 and (内因性混合型高脂血症)
臨床所見	発症時期	小児期	小児期～成人		成人	成人	小児期～成人
	肝脾肥大	＋＋＋	－		＋	＋＋＋脾のみ	＋＋＋
	腹痛	＋				＋	＋
	膵炎	＋					＋
	網膜脂血症	＋					＋
	肥満					＋	＋
	角膜輪		＋		＋
	冠動脈疾患	まれ	最も高率		高率	中程度	比較的まれ
	黄色腫	発疹状	黄色板状結節状腱黄色腫		手掌線結節状発疹状		発疹状
	耐糖能	正常	正常		正常	異常多い	異常多い
	高尿酸血症	なし	なし		少ない	多い	多い
遺伝		劣性遺伝	優性遺伝		劣性遺伝	優性遺伝	不明
頻度		まれ	多い 500人中 1人(ヘテロ) 100万人中 1人(ホモ)	多い 200人中 1人	少ない 1万人中 2-3人	最も多い	まれ
血清静置試験		上層：乳濁	透明	わずかに混濁	混濁、時にミルク状	混濁	上層：乳濁
血清静置試験		下層：透明	透明	わずかに混濁	混濁、時にミルク状	混濁	下層：混濁
特徴				small dense LDL の存在	broad β

頻度：IIa > IIb > IV
遺伝(AR)I, III　(AD)その他
症状

動脈硬化：IIa,IIb,III
膵炎：TG多い：I,IV,V

TC優位に多いのがIIa, TG優位に多いのがIV
リポ蛋白のパターンは、IIa + IV = IIb　で　IIIはその中間(IDL)。I +　IV = V

原発性高脂血症

		血清TG	血清TC
内分泌代謝疾患	甲状腺機能低下症		+++
	クッシング症候群	+	++
	先端性肥大症	+
	糖尿病	+++	+～++
	痛風	+
	神経性食思不振症		++
	ウェルナー症候群		++
肝疾患	閉塞性肝・胆道疾患		+++
肝疾患	肝癌		++
腎疾患	ネフローゼ症候群	++	+++
腎疾患	慢性腎不全	+++
免疫異常	全身性エリテマトーデス	+++
免疫異常	骨髄腫	++	+
薬剤など	サイアザイド	+	+
	β遮断薬	+
	シクロスポリン		+
	経口避妊薬	+++

リスク別脂質管理目標値 (http://jas.umin.ac.jp/pdf/guideline_summary.pdf)

	治療方針の原則	カテゴリー			脂質管理目標値（mg/dL）
		リスク群		LDL-C以外の主要危険因子	LDL-C	HDL-C	TG
一次予防	まず生活習慣の改善を行った後、薬物治療の適応を考慮する	I	低リスク群	0	＜160	≧40	＜150
		II	中リスク群	1～2	＜140
		III	高リスク群	3以上	＜120
二次予防	生活習慣の改善とともに薬物治療を考慮する	冠動脈疾患の既往			＜100

LDL－C値以外の主要危険因子

加齢(男性≧４５歳、女性≧５５歳）、高血圧、糖尿病(耐糖能異常を含む）、喫煙、冠動脈疾患の家族歴、低HDL－C血症(＜４０mg/dL）
糖尿病、脳梗塞、閉塞性動脈硬化症の合併はカテゴリーIIIとする。

「高中性脂肪血症」

　　[★]

英: hypertriglyceridemia
関: 高トリグリセリド血症、高トリグリセライド血症。脂質異常症

[show details]

高中性脂肪血症 : 約 23,700 件
高トリグリセリド血症 : 約 23,900 件

重症度

正常　　　：150mg/dl以下
境界型　　：150-199mg/dl
高値　　　：200-499mg/dl
非常に高値：500mg/dl

原因

アルコール
薬剤：サイアザイド系利尿薬、βブロッカー、エストロゲン、テストステロン、ステロイド、シクロスポリン、バルプロ酸など)
重症の糖尿病
甲状腺機能低下症
末期腎不全
ネフローゼ症候群
HIV感染

臨床的意義

500md/dl以下の場合は非薬物療法(食事療法、接酒、減量、有酸素運動)
500mg/dl以上の場合、フィブラート系薬剤の治療適応
1000mg/dlを超えると膵炎のリスクがある。

治療薬

「高トリグリセリド血症」

　　[★]

英: hypertriglyceridemia
同: 高トリグリセライド血症、高中性脂肪血症
関: トリグリセリド

「hypertriglyceridemic」

　　[★]

高トリグリセリド血症の

関: hypertriglyceridaemia、hypertriglyceridaemic、hypertriglyceridemia

「hypertriglyceridaemic」

　　[★]

高トリグリセリド血症の

関: hypertriglyceridaemia、hypertriglyceridemia、hypertriglyceridemic

「familial hypertriglyceridemia」

　　[★]

家族性高トリグリセリド血症

関: hyperlipoproteinemia type IV

同: FHTG

「hypertriglyceridemias」

　　[★] 高トリグリセリド血症

[CPG2012-1] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Berglund L, Brunzell JD, Goldberg AC, et al. (September 2012). "Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline". J. Clin. Endocrinol. Metab. 97 (9): 2969–89. doi:10.1210/jc.2011-3213. PMC 3431581. PMID 22962670.

[Yuan2007-2] Yuan G, Al-Shali KZ, Hegele RA (April 2007). "Hypertriglyceridemia: its etiology, effects and treatment". CMAJ 176 (8): 1113–20. doi:10.1503/cmaj.060963. PMC 1839776. PMID 17420495.

[Tsuang2009-3] Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A (April 2009). "Hypertriglyceridemic pancreatitis: presentation and management". Am. J. Gastroenterol. 104 (4): 984–91. doi:10.1038/ajg.2009.27. PMID 19293788.

[4] Silva, ME; Pupo, AA; Ursich, MJ (1987). "Effects of a high-carbohydrate diet on blood glucose, insulin and triglyceride levels in normal and obese subjects and in obese subjects with impaired glucose tolerance.". Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.] 20 (3-4): 339–50. PMID 3330460.

[pmid15504577-5] McCarty, MF (2004). "An elevation of triglycerides reflecting decreased triglyceride clearance may not be pathogenic -- relevance to high-carbohydrate diets.". Medical hypotheses 63 (6): 1065–73. doi:10.1016/j.mehy.2002.11.002. PMID 15504577.

[6] Garg, A; Grundy, SM; Unger, RH (Oct 1992). "Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM.". Diabetes 41 (10): 1278–85. doi:10.2337/diabetes.41.10.1278. PMID 1397701.

[7] Pejic RN, Lee DT (May–Jun 2006). "Hypertriglyceridemia". J Am Board Fam Med 19 (3): 310–6. doi:10.3122/jabfm.19.3.310. PMID 16672684.

匿名

検索

案内

案内

hypertriglyceridemia