Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Severe hypertriglyceridemia with a history of treatment failure

Nature Clinical Practice Endocrinology & Metabolism volume 1, pages 53–58 (2005)Cite this article

Abstract

Background A 53-year-old man with a history of hypertension and gout was referred to our clinic for severe hypertriglyceridemia, diagnosed 3 years previously. He was asymptomatic and had no history of abdominal pain, pancreatitis or diabetes, but consumed six cans of beer per night. Over the previous 2 years, he had been treated unsuccessfully with multiple medications; during this period his fasting triglycerides ranged from 5.41 mM to 55.04 mM (479 to 4,871 mg/dl).

Investigations Physical examination including fundoscopy, medication review, and laboratory tests.

Diagnosis Severe hypertriglyceridemia due to a genetic combined hyperlipidemia, exacerbated by persistent excessive alcohol intake and metabolic syndrome.

Management Cessation of alcohol intake, initiation of a fat-restricted diet, and fibrate therapy, with close follow-up. Once serum triglycerides were controlled, attention was turned to lowering LDL-cholesterol concentration according to The National Cholesterol Education Program, Adult Treatment Panel III guidelines.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: The four patterns of hypertriglyceridemia in genetic forms of the disease
Figure 2: Treatment algorithm for hypertriglyceridemia based on clinical experience

References

  1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285: 2486–2497

  2. Chait A and Brunzell JD (1992) Chylomicronemia syndrome. Adv Intern Med 37: 249–273

    CAS  PubMed  Google Scholar 

  3. Eckel RH (1989) Lipoprotein lipase. A multifunctional enzyme relevant to common metabolic diseases. N Engl J Med 320: 1060–1068

    Article  CAS  Google Scholar 

  4. Chait A and Brunzell JD (1983) Severe hypertriglyceridemia: role of familial and acquired disorders. Metabolism 32: 209–214

    Article  CAS  Google Scholar 

  5. Brunzell JD et al. (1973) Evidence for a common, saturable, triglyceride removal mechanism for chylomicrons and very low density lipoproteins in man. J Clin Invest 52: 1578–1585

    Article  CAS  Google Scholar 

  6. Baron TH and Morgan DE (1999) Acute necrotizing pancreatitis. N Engl J Med 340: 1412–1417

    Article  CAS  Google Scholar 

  7. [No authors listed] (1984) Consensus conference: treatment of hypertriglyceridemia. JAMA 251: 1196–1200

  8. Illingworth DR (1990) Treatment of hyperlipidaemia. Br Med Bull 46: 1025–1058

    Article  CAS  Google Scholar 

  9. Santamarina-Fojo S (1998) The familial chylomicronemia syndrome. Endocrinol Metab Clin North Am 27: 551–567, viii

    Article  CAS  Google Scholar 

  10. Yadav D and Pitchumoni CS (2003) Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol 36: 54–62

    Article  CAS  Google Scholar 

  11. Wierzbicki AS et al. (2002) Usefulness of orlistat in the treatment of severe hypertriglyceridemia. Am J Cardiol 89: 229–231

    Article  CAS  Google Scholar 

  12. Yeh JH et al. (2003) Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apheresis 18: 181–185

    Article  Google Scholar 

  13. Heaney AP et al. (1999) Prevention of recurrent pancreatitis in familial lipoprotein lipase deficiency with high-dose antioxidant therapy. J Clin Endocrinol Metab 84: 1203–1205

    Article  CAS  Google Scholar 

  14. Hopkins PN et al. (2003) Coronary artery disease risk in familial combined hyperlipidemia and familial hypertriglyceridemia: a case control comparison from the National Heart, Lung, and Blood Institute Family Heart Study. Circulation 108: 519–523

    Article  Google Scholar 

  15. Capell WH et al. (2004) Therapeutic targets in severe hypertriglyceridemia. Drug Disc Today Dis Mech 1: 171–177

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Assistant Professor of Medicine in the Division of Endocrinology, Metabolism, and Diabetes at the University of Colorado at Denver and Health Sciences Center, CO, USA

    Warren H Capell

  2. Professor of Medicine (Divisions of Endocrinology/Metabolism/Diabetes, Charles A Boettcher Endowed Chair in Atherosclerosis, and Cardiology) and of Physiology and Biophysics, at the University of Colorado at Denver and Health Sciences Center, CO, USA

    Robert H Eckel

Authors
  1. Warren H Capell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert H Eckel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Warren H Capell.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Capell, W., Eckel, R. Severe hypertriglyceridemia with a history of treatment failure. Nat Rev Endocrinol 1, 53–58 (2005). https://doi.org/10.1038/ncpendmet0025

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpendmet0025

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing