Hypertriglyceridemia: A Review of Clinical Relevance and Treatment Options: Focus on Cerivastatin

Hans-Willi M. Breuer, Abteilung für Innere Medizin, St. Carolus-Krankenhaus Görlitz, Carolusstr. 212, 02827 Görlitz, Germany 

Curr Med Res Opin. 2001;17(1):60-73. 

In This Article

Causes of Raised Triglyceride Levels

Most of the fat ingested in a 'normal' unhealthy diet is in the form of TG4. The relationship between a high fat diet and CHD incidence has been proven in epidemiological studies[4].

The most common type II dyslipidemia is caused by over-production of endogenous TGs from free fatty acid (FA) by the liver. An increase in plasma FA also leads to increased secretion of apolipoprotein B[45].TG over-production is stimulated by high dietary fat intake or as a result of metabolic disorders such as the absence of apolipoprotein CII. Apolipoprotein CII is known to activate lipoprotein lipase, which removes TG from VLDL-C, converting it to LDL-C[45]. An increase in endogenous TG production can also be the result of faults in the feedback mechanism to the liver to activate the production of lipases.

Apart from diet, many other causes of raised TG are known:

  • High alcohol intake.

  • Drugs - steroids, beta-blockers, high-oestrogenoral contraceptives. Oral contraceptives increase TG and HDL-C levels by 15-40% and 5-10%, respectively[53]. Women taking oral contraceptives also have an increased risk of cardiovascular disease related to the increased incidence of thrombosis, especially in cigarette smokers.

  • Age - TG levels increase to a greater degree with age in men than in women, although women's TG levels rise dramatically postmenopausally.

  • Weight - TG levels increase with the body mass index[3]. The waist-to-hip ratio, which increases with age, particularly post-menopausally, is also linked to raised TG levels in women[63,64].

  • Diabetes - high VLDL-C is associated with diabetes risk especially in obese patients[3], with the classic diabetic lipid profile of high TG, high TC, low HDL-C and high TC/HDL-C ratio.Weight and blood pressure are also usually higher than in non-diabetics, which compounds the risk[3]. Elevated levels of TG and reduced concentrations of HDL-C are also very common in patients with insulin resistance, leading to impaired glucose tolerance and abnormal fasting plasma glucose levels[51,52,65].

  • Other diseases - hypothyroidism, nephrosis,renal failure, liver disease, Cushing's disease,hypercalcemia, multiple myeloma and systemic lupus erythematous (SLE) may cause secondary hypertriglyceridemia[4]. Hyperlipidemia, associated with multiple myeloma[66], has been treated with melphalan and prednisolone to reduce IgA,which produced a concomitant reduction in TC and TG levels[66].


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