Hypertriglyceridemia

Hypertriglyceridemia is a disorder of the lipid metabolism, which manifests itself in increased triglyceride levels (triacylglycerides) in the blood of over 200 ml/dl. The disease can be genetic, caused by unfavorable external circumstances or manifested as a side effect of other diseases. An existing hypertriglyceridemia is often not noticed due to the lack of direct symptoms, but is considered a high risk factor for arteriosclerosis and thus for heart attacks, inflammation of the pancreas (pancreatitis) and fatty liver.

What is hypertriglyceridemia?

The disease, which usually has no symptoms, can only be diagnosed with a laboratory blood test. Whether this is primary or acquired hypertriglyceridemia cannot be determined in this way. See AbbreviationFinder for abbreviations related to Hypertriglyceridemia.

The word hypertriglyceridemia already indicates pathologically increased triglyceride concentrations in the blood. Generally binding limits are 180 ml/dl to 200 ml/dl blood. If these limit values ​​are exceeded, hypertriglyceridemia is present.

The increased concentration of triglycerides is usually accompanied by an increased concentration of total cholesterol, especially the long-chain LDL fraction (low-density lipoprotein), which is also referred to as “bad” cholesterol, when certain threshold values ​​are exceeded.

LDL cholesterols are suspected of being deposited on the inner walls of vessels in the form of plaques and thus promoting arteriosclerosis. Congenital genetic defects that cause hypertriglyceridemia due to a lack of certain hormones are primary and all others are secondary or acquired.

Causes

Hypertriglyceridemia can be genetic or acquired through external circumstances. It can also occur as a side effect of other diseases. A genetic disorder is present when there is a deficiency in lipoprotein lipase, an enzyme necessary for the catalytic hydrolysis and processing of triglycerides.

Another genetic cause is a lack of apolipoprotein C2, which is considered an activator of lipoprotein lipase and can be the cause of its deficiency. External living conditions and other diseases can also lead to hypertriglyceridemia, e.g. B. Obesity and excessive alcohol consumption.

Diseases that can lead to elevated triglyceride concentrations up to the pathological range are primarily diabetes mellitus, gout and glycogen storage diseases. Taking certain medications such as beta blockers, antivirals and hormonal contraceptives also affect lipid metabolism and can lead to hypertriglyceridemia.

Symptoms, Ailments & Signs

High blood lipid levels do not initially cause any clear symptoms. Only in the course of hypertriglyceridemia do symptoms of the cardiovascular system and internal organs develop. The development of a fatty liver is typical, whereby the blood lipid levels must be greatly increased over a longer period of time.

More often, those affected feel an unspecific feeling of illness or feel generally unwell without a clear cause being recognizable. Physical symptoms that can occur include pain in the limbs, especially in the fingers and toes, as well as circulatory and sensory disturbances. In individual cases, skin changes such as xanthomas or xanthelasmas occur.

These thickenings occur primarily in the area of ​​the knee and elbow joints and are painful when touched. Rarely, hypertriglyceridemia manifests itself as fat deposits in the skin or on the eyelids. However, these symptoms can also occur in healthy people. Externally, the disease can be recognized by the white ring in the cornea of ​​the eye.

This so-called arcus corneau appears after a short time and becomes more and more obvious as the disease progresses. In the long term, hypertriglyceridemia can lead to hardening of the arteries. Possible long-term consequences are a heart attack, stroke or thrombosis.

Diagnosis & History

Triglycerides are important for the body and are partly ingested with food, but to a large extent also synthesized in the liver, kidneys and heart muscle. The facts of hypertriglyceridemia are only fulfilled when a certain limit value is exceeded.

The disease, which usually has no symptoms, can only be diagnosed with a laboratory blood test. It is not possible to determine whether this is primary or acquired hypertriglyceridemia. In some cases, direct symptoms appear in the form of xanthoma or xanthelasma. In the former case it is nodular fat deposits in the skin and in the latter case similar deposits below the eye.

The deposits are harmless and at best represent a cosmetic problem. If the hypertriglyceridemia persists over a longer period of time, cardiovascular diseases in particular can develop. Only an extremely high triglyceride level of over 1,000 ml/dl blood can directly trigger pancreatitis.

Complications

Hypertriglyceridemia primarily increases the risk and probability of a heart attack or fatty liver. Both complaints are very dangerous to health and must be avoided at all costs. For this reason, if left untreated, hypertriglyceridemia can lead to patient death and thus significantly reduce life expectancy.

In most cases, hypertriglyceridemia leads to fat deposits, which can occur under the skin or under the eyes, for example. These fatty deposits reduce blood flow and increase blood pressure. High blood pressure can therefore lead to a heart attack, which is often associated with the premature death of the patient.

Hypertriglyceridemia is usually treated without complications. It is carried out with the help of drugs that may have side effects. In rare cases, patients therefore suffer from muscle wasting and pain in the muscles. In some cases, it can also lead to psychological problems. With early diagnosis and treatment, life expectancy is unaffected by hypertriglyceridemia. However, irreversible damage cannot be reversed even with treatment.

When should you go to the doctor?

Hypertriglyceridemia requires treatment and should be examined by a doctor at the first sign. People with a high body weight, which is classified according to the specifications of the BMI in the area of ​​obesity, need medical support. If you gain a lot of weight or try to lose weight without success, you should consult a doctor. If there are functional disorders or problems with digestion, a doctor must be consulted.

Check-ups are necessary if constipation, diarrhea or abnormal urination occur. Pain in the kidney area is of particular concern and should be evaluated as soon as possible. A weakness in the muscles or a decrease in the usual muscle strength are indications that should be clarified by a doctor. If you have heart rhythm disorders, high blood pressure, heavy sweating or a racing heart, you need to see a doctor.

If it comes to shortness of breath, reduced mobility or problems with the joints, the person concerned needs medical help. Consultation with a doctor is essential in the event of sleep disorders, fat deposits, swelling or yellowing of the skin. Without treatment, the patient is at risk of premature death. Thickening at the joints of the elbows or knees are indications that should be followed up. If there are changes in the cornea or a yellowish tint of the eyeball, a doctor should be consulted.

Treatment & Therapy

In the presence of acquired hypertriglyceridemia, the first therapeutic approach is to change the external disease-promoting circumstances. Medication should only be started if the concentration of triglycerides in the blood has not changed significantly after a few weeks despite a change in lifestyle including exercise therapy.

It is worth noting that effective triglyceride-lowering drugs can only treat the symptoms, not the root causes. Because elevated triglycerides tend to occur with elevated cholesterol, statins are the most effective and most commonly prescribed triglyceride and cholesterol-lowering drugs. Statins inhibit certain cholesterol-forming enzymes in the liver.

An alternative to statins are fibrates from the group of carboxylic acids, which promote the breakdown of fatty acids and thus do not inhibit the synthesis of triglycerides, but rather accelerate their breakdown. Both groups of drugs can have side effects that can lead to myopathies with muscle pain and muscle breakdown.

Recently, bile acid binders have also been used, which inhibit the absorption of fats and cholesterol in the intestine. These agents are largely burdened with only minor side effects because they do not act systemically through the blood, but their physiological activity takes place exclusively in the digestive tract.

Prevention

The most effective way to prevent hypertriglyceridemia is to eat a healthy diet that contains as much natural food as possible, with enzymes and vitamins still intact. Equally important is an exercise program that includes regular but not excessive physical activity.

Compliance with the above measures only protects against secondary (acquired) hypertriglyceridemia and not against the primary form of the disease. In these cases, medication that is as gentle as possible and regular laboratory checks can protect against secondary damage.

Aftercare

The follow-up measures for hypertriglyceridemia focus on a health-conscious diet. Patients should eat as natural food as possible so that their body gets intact enzymes and vitamins. In combination with an individual exercise program, protection against deterioration of the condition is increased. However, the activities should not overload the body.

It is therefore more and more regular to do gentle sports, which are typically moderate endurance training. However, such aftercare is only suitable for the treatment of the secondary disease. In the case of a primary disease, other measures are used.

Here the doctor usually recommends moderate medication and close laboratory control in order to identify secondary damage in good time. The healthier way of life should be followed consistently later in everyday life. This improves the blood values, as the regular examinations show. For patients who are overweight, the doctor also recommends weight reduction.

Low-fat foods and avoiding animal fats support recovery. Sweet, sugary drinks and food as well as white flour baked goods should disappear from the menu or only be consumed in small quantities. Recommended foods with omega-3 fatty acids include nuts, sea fish and flaxseed oil.

You can do that yourself

Since triglycerides are ingested directly with food and can also be produced by the body itself from carbohydrates, diet can make an important contribution to lowering the triglyceride level in the blood. This is particularly the case with the acquired form of hypertriglyceridemia.

Since many of those affected are overweight, weight reduction and a change in lifestyle are essential. For this purpose, a low-fat diet should be followed, in particular animal fats should be avoided. Foods with a high content of saturated omega-3 fatty acids are recommended, such as nuts, linseed oil and sea fish. Sugar and foods containing sugar such as desserts, fruit juices or baked goods should be avoided as much as possible, as the body uses them to form additional triglycerides. Substituting sweeteners is possible here, as they have no effect on the fats. On alcoholthose affected should avoid it completely if possible, it also contains many carbohydrates for the formation of further fats.

In addition to a change in diet, regular physical activity can also counteract the increased blood lipid levels. It is recommended to do moderate endurance training of at least 30 minutes three to five times a week.

Hypertriglyceridemia