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Vol. 30. Issue 5.
Pages 217-223 (September - October 2018)
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Vol. 30. Issue 5.
Pages 217-223 (September - October 2018)
Original article
DOI: 10.1016/j.artere.2018.08.003
Severe hypertriglyceridemia. Clinical characteristics and therapeutic management
Hipertrigliceridemia grave. Características clínicas y manejo terapéutico
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Walter Masson
Corresponding author
, Emiliano Rossi, Daniel Siniawski, Juan Damonte, Ana Halsband, Ramiro Barolo, Miguel Scaramal
Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Tables (4)
Table 1. Characteristics of the population.
Table 2. Secondary causes of hypertriglyceridaemia.
Table 3. Characteristics of the population according to whether or not they were prescribed fibrates after the discovery of severe hypertriglyceridaemia.
Table 4. Characteristics of the population according to whether or not they were advised to take up physical exercise and referred to a dietitian.
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Abstract
Introduction

The therapeutic management of severe hypertriglyceridaemia represents a clinical challenge.

Objectives

The objectives of this study were (1) to identify the clinical characteristics of patients with severe hypertriglyceridaemia, and (2) to analyse the treatment established by the physicians in each case.

Methods

A cross-sectional study was carried out using the computerised medical records of all patients >18 years of age with a blood triglyceride level ≥1000mg/dL between 1 January 2011 and 31 December 2016. Clinical and laboratory variables were collected. The behaviour of the physicians in the 6 months after the lipid finding was analysed.

Results

A total of 420 patients were included (mean age 49.1±11.4 years, males 78.8%). The median of triglycerides was 1329mg/dL (interquartile range 1174–1658). No secondary causes were found in 34.1% of the patients. The most frequent secondary causes were obesity (38.6%) and diabetes (28.1%). Physical activity was recommended and a nutritionist was referred to in 49.1% and 44.2% of the patients, respectively. Secondary causes were identified and attempts were made to correct them in 40.7% of cases. The most indicated pharmacological treatments were fenofibrate 200mg/day (26.5%) and gemfibrozil 900mg/day (19.3%). Few patients received the indication of omega 3 fatty acids or niacin.

Conclusion

This study showed, for the first time in our country, the characteristics of a population with severe hypertriglyceridaemia. The therapeutic measures instituted by the physicians were insufficient. Knowing the characteristics in this particular clinical scenario could improve the current approach of these patients.

Keywords:
Hypertriglyceridaemia
Diabetes
Obesity
Treatment
Resumen
Introducción

El manejo terapéutico de la hipertrigliceridemia grave representa un desafío clínico.

Objetivos

1) Identificar las características clínicas de los pacientes con hipertrigliceridemia grave; 2) Analizar el tratamiento instaurado por el médico en cada caso.

Métodos

Se realizó un estudio de corte transversal a partir de la historia clínica electrónica. Se incluyeron todos los pacientes>18 años con una determinación en sangre de triglicéridos1.000mg/dL entre el 01/01/2011 y el 31/12/2016. Se identificaron variables clínicas y de laboratorio. Se analizó la conducta de los médicos tratantes en los 6 meses posteriores al hallazgo lipídico.

Resultados

Se incluyeron 420 pacientes (edad media 49,1±11,4 años, varones el 78,8%). La mediana de triglicéridos fue 1.329mg/dL (rango intercuartílico 1.174-1.658). En el 34,1% de los pacientes no se encontraron causas secundarias. Las causas secundarias más frecuentes fueron la obesidad (38,6%) y la diabetes (28,1%). Se recomendó realizar actividad física y se derivó a un nutricionista en el 49,1% y el 44,2% de los pacientes respectivamente. Las causas secundarias se identificaron y se intentaron corregir en el 40,7% de los casos. Los esquemas terapéuticos más indicados fueron fenofibrato 200mg/día (26,5%) y gemfibrozil 900mg/día (19,3%). Pocos pacientes recibieron la indicación de ácidos grasos omega 3 o niacina.

Conclusión

Nuestro trabajo mostró por primera vez en nuestro país las características de una población con hipertrigliceridemia grave. Las medidas terapéuticas instauradas por los médicos fueron insuficientes. Conocer las características en este particular escenario clínico podría mejorar el abordaje actual de estos pacientes.

Palabras clave:
Hipertrigliceridemia
Diabetes
Obesidad
Tratamiento

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