Hypertriglyceridemia Is Common Among US Adults

Laurie Barclay, MD
http://www.medscape.com/viewarticle/590457?src=mp&spon=17&uac=71630FV

April 1, 2009 — Hypertriglyceridemia is common among US adults and should be treated with lifestyle change in most cases, according to the results of a study reported in the March 23 issue of the Archives of Internal Medicine.

"Increasing evidence supports triglyceride (TG) concentration as a risk factor for cardiovascular disease," write Earl S. Ford, MD, MPH, from the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues. "The prevalence of hypertriglyceridemia during a period of rising prevalence of obesity and its pharmacological treatment among US adults are poorly understood."

The study sample consisted of 5610 adults aged 20 years or older enrolled in the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2004. Unadjusted prevalence rates (percentages) of TG concentration ranges in milligrams per deciliter were determined (to convert TG to millimoles per liter, multiply by 0.0113).

TG concentration of 150 mg/dL or higher occurred in 33.1% of participants (standard error [SE], 0.8%), a concentration of 200 mg/dL or higher occurred in 17.9% of participants (SE, 0.7%), a concentration of 500 mg/dL or higher occurred in 1.7% of participants (SE, 0.2%), and a concentration of 1000 mg/dL or higher occurred in 0.4% of participants (SE, 0.1%).

Use of 1 of 3 prescription medications indicated to treat hypertriglyceridemia (fenofibrate, gemfibrozil, or niacin) occurred in 1.3% of participants overall (SE, 0.2%), in 2.6% of participants with a TG concentration of 150 mg/dL or higher (SE, 0.4%), and in 3.6% of those with a TG concentration of 200 mg/dL or higher (SE, 0.7%).

"Among US adults, hypertriglyceridemia is common," the study authors write. "Until the benefits of treating hypertriglyceridemia that is not characterized by extreme elevations of TG concentration with medications are incontrovertible, therapeutic lifestyle change remains the preferred treatment."

Limitations of this study include a lack of certainty that the intended use of medications was for lowering elevated TG concentrations rather than raising high-density lipoprotein cholesterol concentrations, as well as the possible effects of oral contraceptives and hormone therapy on TG concentrations in women.

"The prevalence of hypertriglyceridemia is high among US adults, the use of pharmacologic treatment is low, and the prevalence of modifiable causes of hypertriglyceridemia, such as physical inactivity and overweight or obesity, is high," the study authors conclude. "Because measuring TG concentrations is routinely performed in clinical practice, physicians have to regularly decide on the need for treatment in many of their patients. As research clarifies uncertainties in the relation between TG concentration and cardiovascular disease, guidelines to treat hypertriglyceridemia will likely be modified."

In an accompanying commentary, Warren G. Thompson, MD, and Gerald T. Gau, MD, from the Mayo Clinic College of Medicine in Rochester, Minnesota, agree that llifestyle modification is the cornerstone of management of TG concentrations between 150 and 500 mg/dL. They note that if the patient does not make lifestyle changes in diet and exercise, it is difficult to normalize TG concentration with medication alone.

If medications are necessary, Dr. Thompson and Dr. Gau suggest trying statins first, as these have proven effects on mortality.

"Some have argued that statins reduce mortality by only 30% and that additional pharmacologic therapy to treat elevated TG concentration is warranted," Dr. Thompson and Dr. Gau write.

"However, there are no data proving that additional drug treatment will reduce mortality. If statins and lifestyle change are insufficient, then fish oil or niacin should be considered. Fibrates should be reserved for TG concentrations higher than 1000 mg/dL that do not respond to other treatments."

Arch Intern Med. 2009;169:572–578, 578–579.
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Laurie Barclay, MD is a freelance reviewer and writer for Medscape LLC