From the Guidelines
The workup for hypertriglyceridemia should begin with a comprehensive lipid panel to confirm elevated triglyceride levels (>150 mg/dL), ideally after a 12-hour fast, and include a detailed medical history, physical examination, and laboratory testing to identify secondary causes, as recommended by the most recent guidelines 1. The initial evaluation should focus on identifying risk factors such as obesity, diabetes, alcohol consumption, and medication use (like estrogens, retinoids, or corticosteroids) that may be contributing to the elevated triglyceride levels.
- A detailed medical history should be taken to assess for symptoms of metabolic syndrome, xanthomas, or evidence of pancreatitis.
- Physical examination should assess for signs of metabolic syndrome, xanthomas, or evidence of pancreatitis.
- Laboratory testing should include:
- Liver function tests
- Thyroid function tests
- Glucose levels
- HbA1c
- Renal function to identify secondary causes of hypertriglyceridemia, as suggested by 1 and 1. For severe hypertriglyceridemia (>1000 mg/dL), additional testing for genetic disorders like familial hypertriglyceridemia or familial combined hyperlipidemia may be warranted, potentially including apolipoprotein testing or genetic screening, as mentioned in 1. Imaging studies are not routinely needed unless complications like pancreatitis are suspected. This comprehensive approach helps distinguish between primary genetic disorders and secondary causes, which is crucial for determining appropriate treatment strategies that may include lifestyle modifications, dietary changes, and medications such as fibrates, omega-3 fatty acids, or statins depending on the severity and underlying cause, as recommended by 1 and 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Workup for Hypertriglyceridemia
The workup for hypertriglyceridemia involves several steps to determine the underlying cause and to assess the risk of cardiovascular disease and pancreatitis.
- A family history, physical examination, and analysis of the lipid profile, including measurement of apolipoprotein B or non-HDL-C, are necessary to establish the underlying primary or secondary cause 2.
- The time of measurement (fasting or postprandial) should be taken into account when evaluating triglyceride values due to physiological diurnal variations of triglycerides (TG) 2.
- Calculating a patient's 10-year risk of atherosclerotic cardiovascular disease is pertinent to determine the role of medications 3.
Diagnostic Procedures
Diagnostic procedures for hypertriglyceridemia include:
- Confirming the detection opportunity and conditions of blood sampling 4.
- Differentiating secondary hyperlipidemia and assessing other arteriosclerosis risks 4.
- Diagnosing primary hyperlipidemia by examining apoproteins, lipoproteins, and some metabolic enzymes of lipoproteins 4.
Laboratory Examinations
Laboratory examinations for hypertriglyceridemia include:
- Measurement of triglyceride levels, with levels above 1000 mg/dL (11.4 mmol/L) increasing the risk of acute pancreatitis 5.
- Measurement of low-density lipoprotein (LDL) concentration to determine the need for lowering LDL levels based on cardiovascular risk 5.
- Analysis of apolipoprotein B or non-HDL-C to establish the underlying primary or secondary cause of hypertriglyceridemia 2.
Risk Assessment
Risk assessment for hypertriglyceridemia involves: