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Risk of Fasting and Non-Fasting Hypertriglyceridemia in Coronary Vascular Disease and Pancreatitis.

Authors

Bhatt D22, Tannock L23.

Source

Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
2018 May 8.

Author information

1
Professor of Medicine, University of California, San Francisco, CA
2
Chief of Medicine at the University of Washington Medical Center and Professor and Vice Chair of the Department of Medicine, University of Washington
3
Pediatric Endocrinologist and Associate Research Physician in the Skeletal Diseases and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health
4
Professor of Pediatrics and Endocrinology, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
5
Associate Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Ohio State University
6
Professor of Endocrinology and Director of the Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
7
Distinguished Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Associate Chief, Endocrinology and Diabetes Division and Director, Endocrine Clinic, West Los Angeles VA Medical Center, Los Angeles, CA
8
Professor of General Medicine-Endocrinology, First Department of Propaedeutic Internal Medicine, Laiko University Hospital, Athens, Greece
9
Head of the Medicover MVZ Oldenburg; affiliated with the Carl von Ossietzky University and the Technical University of Dresden
10
Professor of Medicine and Chief of the Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, Switzerland
11
Professor of Endocrinology and Metabolism, Centre Lead for Endocrinology and Deputy Institute Director, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England
12
Director of Clinical Research, Hudson Institute of Medical Research; Consultant Endocrinologist, Monash Medical Centre, Melbourne, Australia
13
Dammert Professor of Gerontology and Director, Division of Geriatric Medicine and Director of the Division of Endocrinology, Saint Louis University Medical Center
14
Professor of Pediatrics, Professor of Genetics and Genomic Sciences, and Chief of the Adrenal Steroid Disorders Program, Icahn School of Medicine, Mount Sinai School of Medicine, New York, NY
15
Associate Professor of Medicine and Epidemiology, University of Colorado Anschutz Medical Campus
16
Professor of Medicine, Knight Cardiovascular Institute and the Division of Endocrinology, and Associate Director, Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health and Science University, Portland, OR
17
Professor and Chair, Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
18
Director of the Endocrine/Bone Disease Program, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA; Clinical Professor of Medicine, UCLA School of Medicine, Los Angeles, CA
19
Director of the Diabetes Care Center and Associate Professor of Medicine, University of Washington Medical Center, Seattle, WA
20
Murray Waitzer Endowed Chair for Diabetes Research, Professor of Medicine/Pathology/Neurobiology, Director of Research and Neuroendocrine Unit Division of Endocrine and Metabolic Disorders, Eastern Virginia Medical School, Norfolk, VA
21
Endowed Chair, Cardiovascular Health and Risk Prevention, Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX
22
Fellow, Division of Endocrinology and Molecular Medicine, University of Kentucky, Lexington KY 40536, Department of Veterans Affairs, Lexington KY, Room 553 Wethington Building, 900 S. Limestone, University of Kentucky Lexington, KY, 40536-020
23
Professor and Chief, Division of Endocrinology and Molecular Medicine, University of Kentucky, Lexington KY 40536, Department of Veterans Affairs, Lexington KY, Room 553 Wethington Building, 900 S. Limestone, University of Kentucky, Lexington, KY, 40536-0200, Email: Lisa.Tannock@uky.edu

Excerpt

Cardiovascular disease (CVD) remains a major cause of mortality in the Western world and in spite of the reduction of CVD risk by the use of lipid lowering agents per current treatment goals there remains substantial residual and absolute risk of CVD in high risk populations.Focus on elevated triglyceride (TG) levels deserves renewed attention, particularly as one-third of all adults in the United States suffer from elevated TG and a growing number of people are diagnosed with metabolic syndrome or type 2 diabetes mellitus (T2DM). The dyslipidemia of metabolic syndrome and T2DM is characterized by raised TG concentrations, low high-density lipoprotein cholesterol (HDL-c) concentrations and marked elevations in triglyceride rich lipoproteins (TRL). This triad is now known as atherogenic dyslipidemia. There has been growing data that points towards an association of fasting and non-fasting triglycerides with CVD, including a number of genetic studies suggesting causality. However, the association of TG as an independent risk faster in CVD is confounded by its inverse metabolic relationship with high density lipoprotein (HDL-c) and the heterogeneity of TG lipoproteins.Current guidelines suggest diagnosis of hypertriglyceridemia based on fasting levels where length of fast is recommended to be 9-12 hours. Although non-fasting TG levels may be a better indicator of risk, the lack of standardization of non-fasting TG measurements, lack of specific reference ranges, and the variability of postprandial lipid measurements have hampered their routine clinical use. Current guidelines focus mainly on LDL-c levels; however, lowering TG may provide additional benefit for CVD prevention. Lifestyle changes including dietary changes and exercise play an important role in treatment of hyperlipidemia. Pharmacological agents used in treatment of hypertriglyceridemia include niacin, fibrates, fish oil and statins. Most guidelines recommend treating elevated TG for prevention of pancreatitis. This article will discuss the role of elevated TG in pancreatitis and CVD risk. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.

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