Hypertriglyceridemia is a disorder of fat metabolism manifested by elevated triglyceride (triacylglyceride) levels in the blood of more than 200 ml/dl. The disease may be genetic, caused by adverse external conditions, or manifest as a concomitant of other diseases. Existing hypertriglyceridemia often goes unnoticed because of a lack of direct symptoms, but it is considered a high-risk factor for atherosclerosis and thus for myocardial infarction, inflammation of the pancreas (pancreatitis), and fatty liver.
What is hypertriglyceridemia?
The word hypertriglyceridemia already indicates pathologically elevated triglyceride concentrations in the blood. Generally binding limits are 180 ml/dl to 200 ml/dl of blood. If these limits are exceeded, hypertriglyceridemia is present. In most cases, the increased concentration of triglycerides is accompanied by an increased concentration of total cholesterol, especially the long-chain LDL fraction (low density lipoprotein), which is also known as “bad” cholesterol when certain limits are exceeded. LDL cholesterol is suspected of depositing on the inner walls of blood vessels in the form of plaques and thus promoting arteriosclerosis. Congenital genetic defects that cause hypertriglyceridemia due to a deficiency of certain hormones are primary and all others are secondary or acquired hypertriglyceridemia.
Causes
Hypertriglyceridemia may be genetic or acquired through external life circumstances. Likewise, it may occur as a concomitant of other diseases. A genetic disorder is present when a deficiency in lipoprotein lipase, an enzyme necessary for the catalytic hydrolysis and further processing of triglycerides, is evident. Another genetic cause is a deficiency of apolipoprotein C2, which is an activator of lipoprotein lipase and may be the cause of its deficiency. External life circumstances and other diseases can also lead to hypertriglyceridemia such as obesity and excessive alcohol consumption. Diseases that can lead to elevated triglyceride concentrations to the pathological range are mainly diabetes mellitus, gout and glycogen storage diseases. The use of certain medications such as beta blockers,antivirals, and hormonal contraceptives also affect lipid metabolism and can lead to hypertriglyceridemia.
Symptoms, complaints, and signs
Initially, high blood lipid levels do not cause 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 fat values must be strongly elevated over a longer period of time for this to occur. More frequently, those affected experience an unspecific feeling of illness or feel generally unwell, without a clear cause being identifiable. Physical symptoms that may occur include pain in the limbs, especially in the fingers and toes, as well as circulatory disturbances and sensitivity disorders. In individual cases, skin changes such as xanthomas or xanthelasmas occur. These thickenings occur mainly in the area of the knee and elbow joints and hurt when touched. Rarely, hypertriglyceridemia is manifested by fatty 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 arteriosclerosis. Possible late consequences are heart attack, stroke or thrombosis.
Diagnosis and course
Triglycerides are important for the body and are partly absorbed with food, but to a large extent also synthesized in the liver, kidney, and heart muscle. Only when a certain limit is exceeded is the fact of hypertriglyceridemia fulfilled. The disease, which normally does not manifest itself with symptoms, can only be diagnosed by laboratory testing of the blood. It cannot be determined whether the hypertriglyceridemia is primary or acquired. In some cases, direct symptoms appear in the form of xanthomas or xanthelasma.The former are nodular fatty deposits in the skin and the latter are similar deposits below the eye. The deposits are harmless and are at most a cosmetic problem. If hypertriglyceridemia persists over a longer period of time, cardiovascular sequelae in particular may develop. Only an extremely high triglyceride level of more than 1,000 ml/dl of blood can directly trigger pancreatitis.
Complications
Hypertriglyceridemia primarily increases the risks and probabilities for heart attack or fatty liver. Both of these conditions are very dangerous to health and must be avoided at all costs. For this reason, hypertriglyceridemia without treatment can lead to the death of the patient and thus significantly reduce life expectancy. In most cases, hypertriglyceridemia results in fatty deposits, which can occur under the skin or under the eye, for example. These fat deposits reduce blood flow and thus cause blood pressure to rise. High blood pressure can therefore lead to a heart attack, which is not infrequently associated with premature death of the patient. Treatment of hypertriglyceridemia usually occurs without complications. It is carried out with the help of medications that might show side effects. Therefore, in rare cases, patients suffer from muscle atrophy and pain in the muscles. Furthermore, in some cases, psychological complaints may occur. With early diagnosis and treatment, life expectancy is not affected by hypertriglyceridemia. However, irreversible damage cannot be reversed even with treatment.
When should you see a doctor?
The condition hypertriglyceridemia requires treatment and should be evaluated by a physician at the first signs. People with a high body weight that is classified in the obesity range according to BMI guidelines need medical assistance. If there is a sharp increase in weight or unsuccessful attempts to reduce weight, a visit to the doctor is necessary. If there are dysfunctions or problems with digestion, a doctor must be consulted. Control examinations are necessary if constipation, diarrhea or abnormalities in urination occur. Pain in the kidney area is of particular concern and should be investigated as soon as possible. Weakness of muscles or a decrease in usual muscle strength are indications that should be clarified by a physician. If there are disturbances of the heart rhythm, high blood pressure, heavy sweating or palpitations, a visit to the doctor is necessary. If there is shortness of breath, reduced mobility or problems with the joints, the affected person needs medical help. Consultation with a doctor is essential in the case of sleep disturbances, fatty deposits, swelling or yellowish discoloration of the skin. Without treatment, the affected person 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 to the eyeball, a doctor should be consulted.
Treatment and therapy
In the presence of acquired hypertriglyceridemia, the first therapeutic approach is to change the external circumstances that promote the disease. Only when the concentration of triglycerides in the blood has not changed significantly after several weeks, despite lifestyle changes including exercise therapy, should medication be started. It is worth noting that effective medications to reduce triglyceride levels can only combat the symptoms, not eliminate the actual causes. Because elevated triglyceride levels usually occur with elevated cholesterol levels, statins are the most effective and commonly prescribed triglyceride and cholesterol-lowering drugs. Statins inhibit certain cholesterol-producing enzymes in the liver. An alternative for statins is fibrates from the carboxylic acid group of substances, which promote fatty acid breakdown and thus do not inhibit the synthesis of triglycerides, but accelerate their breakdown. Both groups of drugs can have side effects that can lead to myopathies with muscle pain and also muscle breakdown. Recently, bile acid binders have also been used to inhibit the absorption of fats and cholesterols in the intestine.These agents are largely associated with only minor side effects because they do not act systemically through the blood, but their physiological activity occurs exclusively in the digestive tract.
Prevention
The most effective prevention of hypertriglyceridemia is a healthy diet with as high a proportion as possible of naturally leftover foods with enzymes and vitamins still intact. Equally important is an exercise program that includes regular, but not excessive, physical activity. Following the above measures will only protect against secondary (acquired) hypertriglyceridemia, not the primary form of the disease. In these cases, the gentlest possible medication and regular laboratory monitoring may protect against secondary damage.
Follow-up
Follow-up measures for hypertriglyceridemia focus on a health-conscious diet. Patients should eat foods that are as natural as possible to ensure that their bodies receive intact enzymes and vitamins. Combined with an individualized exercise program, this strengthens protection against worsening of the condition. However, the activities should not overload the body. So more and regular gentle exercise is recommended, which is typically moderate endurance training. However, such aftercare is only suitable for the therapy of the secondary disease. In the case of a primary disease, other measures are used. In this case, the doctor usually recommends moderate medication and close laboratory monitoring in order to detect secondary damage in good time. The healthier lifestyle should be consistently maintained later in everyday life. This improves the blood values, as regular examinations show. For patients who are overweight, the doctor also advises weight reduction. Low-fat foods and the avoidance of animal fats support recovery. Sweet, sugary drinks and foods as well as white flour baked goods should disappear from the menu or be consumed only in small quantities. Recommended foods with omega-3 fatty acids include nuts, sea fish and linseed oil.
Here’s what you can do yourself
Since triglycerides are both directly ingested with food and can be produced by the body from carbohydrates, diet can make an important contribution to lowering triglyceride levels in the blood. This is particularly the case in the acquired form of hypertriglyceridemia. Since many of those affected suffer from obesity, weight reduction and changes in lifestyle habits are essential as a basic prerequisite. To this end, a low-fat diet should be followed, and animal fats in particular should be avoided. Foods with a high content of saturated omega-3 fatty acids, such as nuts, linseed oil and sea fish, are recommended. Sugar and sugary foods such as desserts, fruit juices or baked goods should be avoided as far as possible, as the body forms additional triglycerides from them. It is possible to replace them with sweeteners, as they have no effect on fats. If possible, those affected should completely avoid alcohol, which also contains many carbohydrates for the formation of additional fats. Apart from a nourishing change also by regular sporty activity the increased blood fat values can be worked against. It is recommended to do moderate endurance training of at least 30 minutes three to five times a week.
