Familial hypertriglyceridemia

Causes

Familial hypertriglyceridemia is caused by a genetic defect, which is passed on in an autosomal dominant fashion. This means that if you get a bad copy of the gene from just one of your parents, you will have the condition.

Some people with this condition also have high levels of very low density lipoprotein (VLDL). The reason for the rise in triglycerides and VLDL is not understood.

Familial hypertriglyceridemia does not usually become noticeable until puberty or early adulthood. Obesity, hyperglycemia (high blood glucose levels), and high levels of insulin are often also present and may cause even higher triglyceride levels. Alcohol and estrogen use can make the condition worse.

You are more likely to have this condition if you have a family history of hypertriglyceridemia or heart disease before age 50.

Symptoms

You may not notice any symptoms. Some people with the condition may have coronary artery disease at an early age.

Exams and Tests

The doctor or nurse will perform a physical exam and ask questions about your family history and symptoms.

If you have a family history of this condition, you should have blood tests to check very low density lipoprotein (VLDL) and triglyceride levels. Blood tests usually show a mild to moderate increase in triglycerides (about 200 to 500 mg/dL).

A coronary risk profile may also be done.

Treatment

The goal of treatment is to control conditions that can raise triglyceride levels such as obesity, hypothyroidism, and diabetes.

Your doctor may tell you not to drink alcohol. Because certain birth control pills can raise triglyceride levels, you should carefully discuss their use with your doctor.

Treatment also involves avoiding excess calories and foods high in saturated fats and carbohydrates. See also: Heart disease and diet

If high triglyceride levels persist despite diet changes, medication may be needed. Nicotinic acid, gemfibrozil, and fenofibrate have been shown to lower triglyceride levels in people with this condition.

Outlook (Prognosis)

Losing weight and keeping diabetes under control helps improve the outcome.

Possible Complications

• Pancreatitis
• Coronary artery disease

Prevention

Screening family members for high triglycerides may detect the disease early.

References

Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA:Saunders Elsevier; 2011:chap 47.

Semenkovich, CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 213.

Update Date: 6/4/2012

Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.