What causes hypertriglyceridemia?

From the Guidelines

Hypertriglyceridemia is primarily caused by a combination of genetic factors and lifestyle choices, with the most recent evidence suggesting that lifestyle interventions, such as weight loss, dietary changes, and increased physical activity, are crucial in managing the condition. The main causes of hypertriglyceridemia include:

• Genetics: Inherited disorders of lipid metabolism can lead to elevated triglyceride levels 1
• Obesity: Excess body weight, especially abdominal fat, contributes to increased triglyceride production 1
• Diet: High intake of refined carbohydrates, sugars, and fats can raise triglyceride levels 1
• Lack of physical activity: Sedentary lifestyle reduces the body's ability to metabolize triglycerides efficiently 1
• Medical conditions: Diabetes, hypothyroidism, and kidney disease can contribute to hypertriglyceridemia 1
• Medications: Certain drugs like estrogen, corticosteroids, and some antihypertensives can increase triglyceride levels 1
• Excessive alcohol consumption: Alcohol interferes with triglyceride metabolism in the liver 1

To address hypertriglyceridemia, lifestyle modifications are the first line of therapy, and should be individualized to target the lifestyle triggers that are thought to be the greatest contributors to hypertriglyceridemia 1. These modifications include:

• Maintaining a healthy weight
• Following a low-carb and low-fat diet
• Regular exercise
• Limiting alcohol intake
• Managing underlying medical conditions

In some cases, medications like fibrates, niacin, or omega-3 fatty acids may be prescribed to help lower triglyceride levels 1. Understanding the causes of hypertriglyceridemia allows for targeted interventions to manage and prevent the condition, reducing the risk of associated cardiovascular complications.

From the FDA Drug Label

Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy. Diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus should be looked for and adequately treated. Estrogen therapy, thiazide diuretics and beta-blockers, are sometimes associated with massive rises in plasma triglycerides, especially in subjects with familial hypertriglyceridemia

The causes of hypertriglyceridemia include:

• Excess body weight
• Excess alcoholic intake
• Diseases such as:
  • Hypothyroidism
  • Diabetes mellitus
• Certain medications, such as:
  • Estrogen therapy
  • Thiazide diuretics
  • Beta-blockers 2

From the Research

Causes of Hypertriglyceridemia

• Hypertriglyceridemia can be caused by a combination of genetic and environmental factors, including obesity, uncontrolled diabetes, alcohol misuse, and certain medications 3
• Secondary causes of hypertriglyceridemia include:
  • Obesity
  • Uncontrolled diabetes
  • Alcohol misuse
  • Certain medications
  • High fat diet
  • Excessive alcohol intake
  • Medical conditions such as diabetes mellitus and hypothyroidism 4, 5
• Primary hypertriglyceridemia is caused by genetic defects leading to disordered triglyceride metabolism, and can be classified into different types, including familial chylomicronemia syndrome 4, 5
• Other risk factors for hypertriglyceridemia include:
  • Metabolic syndrome
  • Type 2 diabetes mellitus
  • Physical inactivity
  • Being overweight
  • Use of certain medications
  • Genetic disorders 6, 7

Genetic and Acquired Causes

• Monogenic disorders can cause severe hypertriglyceridemia, but in most patients, triglyceride elevations result from a combination of multiple genetic variations with small effects and environmental factors 3
• Acquired causes of hypertriglyceridemia include lifestyle factors such as diet and physical activity, as well as certain medical conditions and medications 4, 5
• The etiology of hypertriglyceridemia determines the treatment strategy, and a family history, physical examination, and analysis of the lipid profile are necessary to establish the underlying primary or secondary cause 7

Lifestyle and Environmental Factors

• Lifestyle modifications, such as dietary changes, increased physical activity, and weight loss, can help lower triglyceride levels and reduce the risk of cardiovascular disease and pancreatitis 3, 4, 6
• A low saturated fat, carbohydrate-controlled diet, combined with alcohol reduction, smoking cessation, and regular aerobic exercise, can help lower triglyceride levels 5
• Increased awareness of the impact of postprandial hypertriglyceridemia on the development of atherosclerosis highlights the importance of lifestyle modifications and treatment strategies aimed at reducing the secretion of triglyceride-rich lipoproteins and increasing intravascular lipolysis 7