Do corticosteroids (steroid hormones) raise triglyceride levels?

Corticosteroids and Triglyceride Levels

Yes, corticosteroids can raise triglyceride levels and are recognized as a secondary cause of hypertriglyceridemia. 1

Mechanism of Action

Corticosteroids elevate triglycerides through several mechanisms:

• Increased very low-density lipoprotein (VLDL) production in the liver 2
• Development of insulin resistance 2
• Impaired glucose tolerance 2
• Decreased lipoprotein lipase activity, which is responsible for triglyceride clearance 3
• Elevated free fatty acid levels that contribute to increased hepatic triglyceride production 3

Evidence from Guidelines and Research

The American Heart Association specifically lists steroids among medications that can cause very high triglycerides that may be associated with pancreatitis 1. Similarly, the Endocrine Society guidelines identify corticosteroids as a secondary cause of hyperlipidemia that should be evaluated in patients with elevated fasting triglyceride levels 1.

Research studies have demonstrated variable effects:

• Short-term, low-dose corticosteroid treatment (prednisone) showed wide individual variation in triglyceride response, with some patients experiencing significant increases 4
• Prednisone-treated patients with systemic lupus erythematosus had significantly higher mean plasma triglyceride levels (2.06 mmol/L) compared to untreated patients (1.15 mmol/L) and normal controls (0.95 mmol/L) 5
• Different corticosteroids have varying effects on lipid profiles - hydrocortisone showed minimal effect on triglycerides, while triamcinolone and dexamethasone significantly increased triglyceride levels 6

Clinical Implications

1. Risk assessment:

   • Baseline lipid profile should be obtained before starting corticosteroid therapy 2
   • Regular monitoring of triglyceride levels is recommended, particularly 1-2 months after initiating therapy 2

2. Risk factors for severe hypertriglyceridemia with corticosteroids:

   • Pre-existing hyperlipidemia
   • Diabetes mellitus
   • Concurrent use of other medications that raise triglycerides
   • Higher doses of corticosteroids 1

3. Management strategies:

   • Use the lowest effective dose of corticosteroids for the shortest duration possible 1
   • Consider dietary modifications (reduced intake of simple carbohydrates and saturated fats)
   • For severe hypertriglyceridemia (>500 mg/dL), consider lipid-lowering medications 1
   • Fibrates are first-line treatment for severe hypertriglyceridemia with risk of pancreatitis 1

Important Considerations

• The risk of pancreatitis increases significantly when triglyceride levels exceed 1000 mg/dL 2
• Long-term, high-dose corticosteroid use poses greater risk for significant triglyceride elevation than short-term or low-dose therapy 1
• When corticosteroids are combined with other medications like L-asparaginase, the hypertriglyceridemic effect can be dramatically enhanced 7
• The anti-inflammatory benefits of corticosteroids may sometimes outweigh the metabolic risks, requiring careful risk-benefit assessment

In clinical practice, awareness of this side effect is important for monitoring and early intervention to prevent complications like pancreatitis in patients requiring corticosteroid therapy.