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 and dietary changes, are the first line of therapy for managing the condition 1. The main causes of hypertriglyceridemia include:
- Obesity and excess body weight
- High-carbohydrate diets, especially those rich in simple sugars
- Excessive alcohol consumption
- Lack of physical activity
- Certain medical conditions like diabetes, hypothyroidism, and kidney disease
- Genetic disorders affecting lipid metabolism
- Medications such as estrogen, corticosteroids, and some antipsychotics To address hypertriglyceridemia, lifestyle modifications should be prioritized first, with a focus on reducing intake of refined carbohydrates and saturated fats, increasing physical activity, maintaining a healthy weight, and limiting alcohol consumption 1. If triglyceride levels remain high despite these changes, medications like fibrates (e.g., fenofibrate) or omega-3 fatty acids may be prescribed. The underlying mechanism involves either increased production or decreased clearance of triglyceride-rich lipoproteins, with excess carbohydrates and fats in the diet leading to increased triglyceride synthesis in the liver, while genetic factors can impair the breakdown and clearance of triglycerides from the bloodstream 1. Key considerations in managing hypertriglyceridemia include:
- Evaluating patients for secondary causes of hyperlipidemia and treating accordingly
- Assessing cardiovascular risk factors, such as central obesity, hypertension, and abnormal glucose metabolism
- Using lifestyle interventions and medications, such as fibrates and omega-3 fatty acids, to reduce triglyceride levels and modify cardiovascular risk
- Monitoring patients for signs of pancreatitis, particularly those with severe or very severe hypertriglyceridemia 1.
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, including:
- Estrogen therapy
- Thiazide diuretics
- Beta-blockers 2
From the Research
Causes of Hypertriglyceridemia
- Hypertriglyceridemia is caused by a combination of genetic and environmental factors, including obesity, uncontrolled diabetes, alcohol misuse, and certain medications 3
- Secondary causes of hypertriglyceridemia include high fat diet, excessive alcohol intake, certain medications, and medical conditions such as diabetes mellitus and hypothyroidism 4
- Genetic disorders, such as familial chylomicronemia syndrome, can also cause hypertriglyceridemia 5
- Lifestyle factors, including physical inactivity and being overweight, can also contribute to hypertriglyceridemia 6
Genetic and Acquired Causes
- Monogenic disorders, such as lipoprotein lipase deficiency, can cause severe hypertriglyceridemia 7
- Polygenic causes, including multiple genetic variations with small effects, can also contribute to hypertriglyceridemia 3
- Acquired causes, such as metabolic syndrome and type 2 diabetes mellitus, can also lead to hypertriglyceridemia 5, 6
Risk Factors
- Obesity, metabolic syndrome, and type 2 diabetes mellitus are common risk factors for hypertriglyceridemia 5, 6
- Excessive alcohol use, physical inactivity, and being overweight are also risk factors for hypertriglyceridemia 6
- Certain medications, such as those used to treat diabetes and high blood pressure, can also increase the risk of hypertriglyceridemia 3