When Triglycerides Skyrocket: Recognizing and Treating Severe Hypertriglyceridemia

Video Transcription

Video Summary

Dr. Robert H. Eckel's webinar focused on severe hypertriglyceridemia (HTG), a rare condition affecting about 1-2 in 1000 people, with critical implications such as pancreatitis risk. He differentiated between familial chylomicronemia syndrome (FCS)—a monogenic disorder with almost absent LDL and low cardiovascular disease risk—and multifactorial chylomicronemia syndrome (MCS), which is polygenic with secondary contributors like diabetes, obesity, alcohol, hypothyroidism, and medications. Diagnostic tools include scoring systems and genetic testing. FCS typically presents earlier with lean patients, whereas MCS affects older, overweight individuals with insulin resistance.<br /><br />Treatment priorities focus on reducing triglycerides below 1000 mg/dL to prevent pancreatitis, primarily via very low-fat diets (<5% fat temporarily), abstaining from alcohol, and controlling secondary factors. Drug therapies such as fibrates and omega-3s are only effective after triglycerides drop below 1000 mg/dL; thus, drugs are paused during extreme elevations then reinstated. New treatments targeting ApoC3 with antisense oligonucleotides (e.g., olisarsen, plosicirin) show promise in FCS by reducing triglycerides and pancreatitis episodes. Plasmapheresis and insulin infusions are reserved for refractory or diabetic cases.<br /><br />Dr. Eckel emphasized frequent triglyceride monitoring, multidisciplinary care including dietitians for strict dietary adherence, and genetic confirmation where indicated. Proper management reduces pancreatitis risk, controls lipid abnormalities, and addresses cardiovascular risk in multifactorial cases, improving patient outcomes.

Keywords

severe hypertriglyceridemia

familial chylomicronemia syndrome

multifactorial chylomicronemia syndrome

triglyceride management

pancreatitis risk

very low-fat diet

ApoC3 antisense oligonucleotides

fibrates and omega-3 therapy

genetic testing