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March 2, 1984

Treatment of Hypertriglyceridemia

JAMA. 1984;251(9):1196-1200. doi:10.1001/jama.1984.03340330054025

Major advances in the understanding and definition of the hyperlipidemias have occurred during the past 15 years. Treatment of the common forms of hyperlipidemia, including hypertriglyceridemia, is often undertakento prevent atherosclerotic cardiovascular disease, although current data do not definitively demonstrate that such therapy achieves its objectives. It is possible to normalize or substantially reduce elevated triglyceride levels in the majority of persons using dietary intervention and/or medications. The frequency with which hypertriglyceridemia is diagnosed in the population, the controversy concerning the association of plasma triglyceride levels and cardiovascular disease, and the potential need for lifelong therapy have made consideration of this topic timely.

To resolve some of these questions, the National Institutes of Health, Bethesda, Md, convened a Consensus Development Conference on the treatment of hypertriglyceridemia on Sept 27 to 29, 1983. After 1 1/2 days of expert presentation of the available data, a consensus panel consisting of lipidologists, cardiologists, primary care physicians, epidemiologists, and experts in exercise considered the evidence and agreed on answers to the following questions:

  1. What is hypertriglyceridemia?

  2. What is the evidence that plasma triglycerides are associated with disease?

  3. What patients with hypertriglyceridemia are candidates for therapy?

  4. What can be achieved with dietary and other therapies?

  5. What should BE guidelines for dietary and drug therapy?

  6. What should be the direction for future research?

Conclusions  Careful evaluation of existing data indicates that in the presence of normal cholesterol levels, mild elevations of plasma triglyceride levels do not necessarily increase the risk for cardiovascular disease. When triglyceride levels are less than 250 mg/dL, risk generally does not exceed that of other Americans, and changes in life-style are unnecessary beyond those recommended for the general public. The same can be said for many normocholesterolemic persons with borderline hypertriglyceridemia who have no risk factors for or family history of cardiovascular disease. However, triglyceride levels in the range of 250 to 500 mg/dL can be a marker for secondary disorders for a subset of patients with genetic forms of hyperlipoproteinemia who are at increased risk and who need specific therapy. Dietary intervention is the primary approach to therapy in these patients, but drugs have a role in selected persons not responding to dietary management. Finally, the danger of pancreatitis is present in frank hypertriglyceridemia (triglyceride level, >500 mg/dL), and the lowering of triglyceride levels by diet and, if necessary, by drugs is indicated.