Hypertriglyceridaemia

Question 1

Definition of Hypertriglyceridaemia

Answer 1

• Fasting plasma triglyceride level ≥2.3mmol/L (200mg/dL)
• 150-199mg/dL is borderline high
• 200-499mg/dL is high
• ≥500mg/dL is very high

Question 2

Aetiology of Hypertriglyceridaemia

Answer 2

• Primary
  
  • Familial hypertriglyceridaemia
  • Familial combined dyslipidaemia
  • Polygenic hypercholesterolaemia
  • Broad beta disease
• Secondary
  
  • Diabetes mellitus
  • Lipodystrophies (i.e. metabolic syndrome, hypothyroidism, renal disease, liver disease)
  • Spinal cord injury
  • Anorexia nervosa
  • Excess EtOH intake
  • SLE
  • Sarcoidosis
  • Cystic fibrosis
  • HIV infection
  • Myeloma
  • Drugs (i.e. glucocorticoids, oestrogens, some antihypertensives like non-selective BBs)

Question 3

Signs and Symptoms of Hypertriglyceridaemia

Answer 3

• Signs/symptoms include FHx of hyperlipidaemia, FHx of diabetes, high BMI, high saturated fat diet, high carbohydrate diet, insulin resistance, liver disease, hypothyroidism, renal disease, excess EtOH consumption, HIV infection and cystic fibrosis.
• Risk factors include high BMI, diabetes mellitus, CAD and angina/claudication.

Question 4

Pathophysiology of Hypertriglyceridaemia

Answer 4

• Triglyceride-rich lipoprotein particles arise from exogenous dietary fats absorbed in the GI tract which form triglyceride-rich chylomicron particles and are secreted into the blood and cleared by the liver. The liver also secretes triglyceride rich VLDL particles.
• These particles are broken down by lipoprotein lipases in tissues for energy.
• When lipoprotein lipase activity is decreased, the clearance of both particles is impaired, resulting in accumulation in the blood.

Question 5

Investigation of Hypertriglyceridaemia

Answer 5

• Fasting triglycerides
  
  • ≥2.3mmol/l (200mg/dL)