Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hypertriglyceridemia 775

management

What to Do First

■Establish whether secondary causes

■Assess cardiovascular risk factors

➣Men≥45 years

➣Women≥55 years

➣Family history of premature cardiovascular disease (≤55 in male

or≤65 in female first-degree relative)

➣Current smoking

➣Hypertension

➣Diabetes mellitus

➣HDL cholesterol <40 mg/dl (≥60 mg/dl is a negative risk factor)

General Measures

■Diet: reduce saturated fat (10%), total fat intake <30% of calories

➣if triglycerides >>1,000 mg/dl reduce total fat intake to 5–15% of

calories

■weight loss if indicated

■Regular exercise

■If diabetes mellitus, aggressively manage glucose control

■If alcohol, reduce intake

■If estrogen, reduce dose

■If pancreatitis, NPO and intravenous glucose

■Treatment goals

➣Primary prevention

No other cardiovascular risk factors:

Triglycerides <500 mg/dl

Adults with=2 other cardiovascular risk factors

■Triglycerides <150 mg/dl

➣Secondary prevention or diabetes mellitus or family history of

early cardiovascular disease

Triglycerides=<150 mg/dl

specific therapy

■Fibrates

➣clofibrate, gemfibrozil, fenofibrate, gemfibrozil and fenofibrate

preferred

➣usually first line agents due to high incidence of adverse effects

with niacin

➣25–60% reduction in triglycerides, 10% reduction in total choles-

terol, LDL cholesterol may increase, not change or decrease,

increase HDL cholesterol