What Are the Different Types of Hypertriglyceridemia Treatment?
Hypertriglyceridemia is a disorder of heterogeneous triglyceride protein synthesis or degradation. It is an important risk factor for the occurrence of metabolic syndrome-related diseases such as coronary heart disease, hypertension, and diabetes. Active control of high triglycerides is an important part of the primary prevention of metabolic syndrome-related diseases.
Basic Information
- English name
- hypertriglyceridemia
- Visiting department
- Department of Endocrinology, Cardiovascular Medicine
- Common causes
- Related to metabolic diseases, certain disease states, hormones and drugs, etc.
- Common symptoms
- In severe cases, hepatosplenomegaly, rash-like yellow tumors of the limbs, etc.
- Contagious
- no
Causes of hypertriglyceridemia
- According to the cause, hypertriglyceridemia can be divided into two types, that is, primary and secondary. Primary hypertriglyceridemia includes familial hypertriglyceridemia, familial mixed dyslipidemia, familial abnormal -lipoproteinemia, and the like. The causes of secondary hypertriglyceridemia mainly include metabolic diseases, certain disease states, hormones and drugs.
- Diabetes
- In patients with uncontrolled type 1 diabetes and ketosis, significant hypertriglyceridemia is often associated with severe insulin deficiency. Hyperinsulinemia in patients with type 2 diabetes often causes excessive secretion of endogenous insulin to compensate for the original insulin resistance. This severe hyperinsulinemia causes triglycerides due to its apparently weakened activation of lipoprotein lipase The level rises.
- Kidney disease
- The mechanism of dyslipidemia in kidney disease is mainly due to increased synthesis of very low density lipoprotein (VLDL) and low density lipoprotein (LDL).
- 3. Hypothyroidism
- This condition is often associated with elevated plasma triglyceride concentrations. This is mainly because the reduction of liver triglyceride enzymes delays VLDL clearance, and it may be combined with intermediate density lipoprotein (IDL) to produce too much.
- 4. Obesity
- In obese patients, the production of VLDL is significantly increased due to the excessive synthesis of apolipoprotein B in the liver.
- 5. Fat malnutrition (lipid metabolism disorder)
- It may be caused by a decrease in lipoprotein lipase in adipose tissue or an increase in liver synthesis of VLDL.
- 6. Hyperuricemia
- About 80% of patients with gout have hypertriglyceridemia. Conversely, 80% of patients with hypertriglyceridemia have hyperuricemia.
- 7. Glycogen accumulation disease (type I)
- The disease is characterized by glucose-6-phosphatase deficiency, and patients are sensitive to hypoglycemia. When hypoglycemia occurs, adipose tissue is mobilized for energy supplementation, the concentration of free fatty acids and the triglyceride content in VLDL increase.
- 8. Heteroproteinemia
- This condition can be seen in patients with systemic lupus erythematosus or multiple bone marrow, which causes hypertriglyceridemia due to the inhibition of clearance of chylomicrons (CM) and VLDL in plasma by atypical proteins.
- 9. Effects of sex hormones
- The effects of estrogen on blood lipids are dual. In postmenopausal women, cholesterol in the plasma increases. However, estrogen itself can reduce plasma lipase activity (especially liver triglyceride lipase), thereby preventing clearance of CM and VLDL in circulating blood.
- 10. Nutritional factors
- Many nutritional factors can cause elevated plasma triglyceride levels. Large intake of monosaccharides can also cause elevated plasma triglyceride levels, which may be related to concomitant insulin resistance; it may also be because monosaccharides can change the structure of VLDL and affect its clearance rate.
- Eating too much sugar causes high blood sugar, increased insulin secretion, and hyperinsulinemia. The latter can increase the liver's synthesis of triglycerides and VLDL, thereby causing an increase in plasma triglyceride concentrations.
- Drinking alcohol also has a significant effect on plasma triglyceride levels. Alcohol can increase the rate of lipid synthesis in the body, reduce the proportion of oxidized fatty acids, and increase the proportion of esterified fatty acids. In addition, alcohol can reduce the activity of lipoprotein esterase, and slow down the triglyceride catabolism.
- 11. Effects of drugs
- Many drugs can reduce or exacerbate hypertriglyceridemia. The two most common drugs are antihypertensive drugs and steroid hormones.
- Another class of drugs that have a significant effect on plasma triglycerides are steroid hormones, the most commonly used of which is estrogen. Whether it is used for hormone replacement therapy or made as an oral contraceptive, plasma triglyceride levels are increased, especially for patients with existing hypertriglyceridemia. Glucocorticoids can also increase plasma triglyceride concentrations.
- 12. Lifestyle
- People who are used to meditation have higher plasma triglyceride concentrations than those who do exercise. Whether long-term or short-term physical exercise can reduce plasma triglyceride levels.
- Smoking can also increase plasma triglyceride levels. Epidemiological studies have confirmed that smoking can increase plasma triglyceride levels by 9.1% compared to the normal average.
- 13. Genetic abnormalities
- CM and VLDL assembled genes, lipoprotein lipase and ApoCII genes, and ApoE gene abnormalities can cause hypertriglyceridemia.
Clinical manifestations of hypertriglyceridemia
- The consequence of high triglycerides is that it is easy to cause "blood thick", that is, blood thick caused by excessive lipid content in the blood, is deposited on the blood vessel wall, and gradually forms small plaques, that is, atherosclerosis. These massive deposits on the wall of the blood vessel will gradually increase the area and thickness, making the inner diameter of the blood vessel smaller and the blood flow slower. The slower blood flow accelerates the process of clogging the blood vessels. In severe cases, the blood flow is even interrupted. In addition to the interruption of blood flow, the obstruction can also cause blood clots; no matter where the high triglyceride occurs, the damage to the body is very serious. If it is in the heart, it can cause coronary heart disease and myocardial infarction; in the brain, it can cause stroke and stroke; it can occur in the fundus, causing vision loss and blindness; if it is in the kidney, it can cause renal failure; in the lower limbs, it can cause limb blood Poor flow leads to necrosis.
Hypertriglyceridemia test
- Check item
- Includes total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides.
- 2. Notes
- (1) The subject should be in a stable metabolic state before blood lipid analysis, and maintain general dietary habits and stable weight for at least 2 weeks.
- (2) Vigorous physical exercise should not be performed within 24 hours before the measurement.
- (3) If the blood lipid test is abnormal, the measurement should be repeated again or more within 2 months, but at least 1 week apart;
- (4) Blood should be collected after fasting for at least 12 hours before testing triglycerides.
- (5) Except for those who are not bedridden, usually take a seat during blood collection. The subjects should rest for at least 5 minutes before blood collection.
- (6) The tourniquet banding during venipuncture should not exceed 1 minute.
- (7) Serum or plasma samples are suitable for the determination of blood lipids and lipoproteins, but because anticoagulants can interfere with some testing techniques (especially involving immune responses), it is recommended to use serum to determine triglycerides.
Diagnosis of hypertriglyceridemia
- Diagnosis is mainly based on blood lipid tests. NCEPATP III defines normal triglyceride levels at 150 mg / dl. If the triglyceride is greater than 1000 mg / dl, quantitative analysis should be performed by ultracentrifugation and electrophoresis to determine the abnormal properties of dyslipidemia. The two most common types of dyslipidemia are familial mixed hyperlipidemia (type IIb) and familial hypertriglyceridemia (type IV). In type IIb dyslipidemia, total cholesterol, low-density lipoprotein, and triglyceride levels increased. In type IV dyslipidemia, total cholesterol and low-density lipoprotein levels are normal, while triglyceride levels rise, often between 500-1000 mg / dl. Patients with type IV dyslipidemia are very sensitive to dietary adjustments. The discovery of hypertriglyceridemia often provides clues for the diagnosis of metabolic syndrome. In this case, the patient should be evaluated for fasting hyperglycemia, hypertension, abdominal obesity, and reduced high-density lipoprotein levels. At the same time, patients with thyroid and renal functions such as thyroid hormone, serum urea nitrogen, creatinine and urine routine indicators should also be evaluated. Patients should be checked for basal liver function before medication. If pancreatitis is suspected clinically, blood amylase and lipase levels should also be checked. Fasting insulin levels can help find if a patient has insulin resistance. When fasting insulin is above 15ug / ml, it is abnormal. At this time, the fasting blood glucose to fasting insulin ratio should be calculated, which is a more sensitive and specific indicator for the diagnosis of insulin resistance. The ratio is normally> 4.5, and <4.5 indicates insulin resistance.
Treatment of hypertriglyceridemia
- The degree of triglyceride elevation is different, and its control purpose and strategy are also different.
- 1. Edge rise (1.7 2.26mmol / L)
- Actively improve lifestyles, such as controlling diet, limiting alcohol consumption, and exercising to reduce weight.
- 2. Mild to moderate increase (2.27 5.63mmol / L)
- Drug intervention should be given, and statins, fibrates, or niacin drugs can be used alone or in combination according to their lipid profile.
- 3. Severe increase (> 5.65mmol / L)
- The main purpose of treatment is to reduce triglyceride levels as soon as possible to prevent the occurrence of acute pancreatitis.
Hypertriglyceridemia prevention
- 1. Control your weight
- Overweight or obese patients lose 5% to 10% of their body weight, and triglycerides can be reduced by about 20%. According to the standards of Chinese residents, body mass index (BMI) 24kg / m 2
- To be overweight, BMI 28kg / m 2 is obese, and strive to achieve normalization of BMI, or to reduce weight by at least 10% within 1 year.
- 2. Reasonable diet
- By controlling total calories in your diet, limiting carbohydrate and fat intake, and increasing vegetable and high-quality protein intake.
- 3. Limit drinking
- Alcoholism is a common cause of elevated triglycerides.
- 4. Right amount of exercise
- Regular physical activity can help you lose weight and directly reduce triglycerides.
- 5. Quit smoking
- Quitting smoking can significantly reduce the overall risk of cardiovascular disease in patients.