Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
BMJ. 2020 Oct 12;371:m3109. doi: 10.1136/bmj.m3109.
Hypertriglyceridemia is one of the most common lipid abnormalities encountered in clinical practice. Many monogenic disorders causing severe hypertriglyceridemia have been identified, but in most patients triglyceride elevations result from a combination of multiple genetic variations with small effects and environmental factors. Common secondary causes include obesity, uncontrolled diabetes, alcohol misuse, and various commonly used drugs. Correcting these factors and optimizing lifestyle choices, including dietary modification, is important before starting drug treatment. The goal of drug treatment is to reduce the risk of pancreatitis in patients with severe hypertriglyceridemia and cardiovascular disease in those with moderate hypertriglyceridemia. This review discusses the various genetic and acquired causes of hypertriglyceridemia, as well as current management strategies. Evidence supporting the different drug and non-drug approaches to treating hypertriglyceridemia is examined, and an easy to adopt step-by-step management strategy is presented.
高甘油三酯血症是临床实践中最常见的脂质异常之一。已经发现了许多导致严重高甘油三酯血症的单基因疾病，但在大多数患者中，甘油三酯升高是多种遗传变异与小效应和环境因素共同作用的结果。常见的继发性原因包括肥胖、未控制的糖尿病、酒精滥用和各种常用药物。在开始药物治疗之前，纠正这些因素和优化生活方式选择，包括饮食调整，非常重要。药物治疗的目的是降低严重高甘油三酯血症患者发生胰腺炎的风险，以及中度高甘油三酯血症患者发生心血管疾病的风险。本文讨论了高甘油三酯血症的各种遗传和获得性原因，以及当前的管理策略。本文还检查了支持不同药物和非药物治疗高甘油三酯血症方法的证据，并提出了一个易于采用的逐步管理策略。
