ATLANTA, March 23 -- One out of three U.S. adults has an elevated
triglyceride level, but very few receive treatment for the probable
cardiovascular risk factor, researchers here found.
In fact, only 1.3% used one of three medications indicated to treat
hypertriglyceridemia, Earl Ford, M.D., M.P.H., of the CDC, and colleagues
reported in the March 23 Archives of Internal Medicine.
They said the low medication rate likely reflects uncertainty about the need for
pharmacological treatment of moderately high triglyceride concentrations.
"Until the benefits of treating hypertriglyceridemia that is not characterized
by extreme elevations of triglyceride concentration with medications are
incontrovertible, therapeutic lifestyle change remains the preferred treatment,"
they said.
Because of mounting evidence that an elevated triglyceride concentration is a
risk factor for cardiovascular disease, it is important to find out how common
the condition is and how often it is treated, they said.
So they examined data on 5,610 participants ages 20 and older from the National
Health and Nutrition Examination Surveys gathered between1999 to 2004. There
were roughly equal numbers of men and women.
Triglyceride concentration varied widely, from 26 to 3,780 mg/dL (mean 147.4).
Overall, 33.1% had a level considered elevated at 150 mg/dL or higher. Another
17.9% had a level 200 mg/dL or higher, while 1.7% had a level 500 mg/dL or
higher, and 0.4% had a level 1,000 mg/dL or higher.
Triglyceride levels were slightly higher when the use of medications known to
lower triglyceride levels -- statins, fenofibrate, gemfibrozil, and niacin --
was taken into account.
Women were significantly less likely to have elevated triglyceride
concentrations than men (P<0.001).
For both sexes, those who exercised less than 150 minutes a week were
significantly more likely to have a triglyceride concentration of 200 mg/dL or
higher (P=0.03).
The prevalence of high total cholesterol (200 mg/dL or higher) rose with
increasing triglyceride concentration: 39.1% for levels less than 150 mg/dL,
58.6% for 150 to 200 mg/dL, and 70.5% for 200 mg/dL or higher.
High LDL and low HDL cholesterol were also more prevalent among participants
with elevated triglyceride concentrations.
About one 10 (10.5%) had a combination of high total cholesterol, high
triglyceride concentration, and low HDL cholesterol.
The researchers said the usefulness of drugs for high triglyceride levels is
unclear for patients with concentrations up to 500 mg/dL.
The 2001 report from the National Cholesterol Education Program said there was
no need for medication at levels from 150 to 199 mg/dL and that lifestyle
changes should be sufficient.
For patients with concentrations from 200 to 499, lifestyle modification should
still be the initial therapy, followed by medication if necessary, the report
said.
Benefits of pharmacological therapy are clearer for patients with triglyceride
concentrations of 500 mg/dL or higher, who are at risk for pancreatitis, the
report said. But lifestyle modification should still be included as part of
treatment.
However, Dr. Ford and colleagues acknowledged, "the high percentages of
participants with a triglyceride concentration of 200 mg/dL or higher who were
overweight or obese, who failed to engage in physical activity for approximately
150 minutes per week, or who smoked attest to the challenge confronting
healthcare providers in working with their patients to implement therapeutic
lifestyle changes."
In an invited commentary, Warren Thompson, M.D., and Gerald Gau, M.D., of the
Mayo Clinic in Rochester, Minn., said "there is little doubt that triglyceride
concentration represents an important risk factor."
They noted, however, that it's not clear whether reducing triglyceride levels
lowers cardiovascular risk.
No individual trials of fibrates have demonstrated a reduction in cardiac or
total mortality, and there is little information on the effects of niacin, they
said.
Lifestyle changes remain the cornerstone of treatment for patients with
triglyceride concentrations from 150 to 500 mg/dL, they said.
However, they noted, "if pharmacologic therapy is deemed necessary, statins have
proven effects on mortality and should be tried first."
If that doesn't work, they said, fish oil and niacin can be tried, with fibrates
reserved for patients with concentrations of 1,000 mg/dL or higher who have not
responded to other treatments.
Primary source: Archives of Internal Medicine
Source reference:Ford E, et al "Hypertriglyceridemia and its pharmacologic
treatment among U.S. adults" Arch Intern Med 2009; 169: 572-578.
