New guidelines: Screen adults for hypertriglyceridemia every 5 years

An Endocrine Society task force has established new clinical-practice guidelines that recommend screening adults for high triglyceride levels once every 5 years because of the potential risk of cardiovascular disease and pancreatitis associated with hypertriglyceridemia.

The new recommendations are published in the September 2012 issue of the Journal of Clinical Endocrinology & Metabolism.

Task-force chair Lars Berglund, MD, PhD, with the University of California, Davis, and colleagues, received approval to recommend the following:

Diagnosis of hypertriglyceridemia should be based on fasting levels

Mild and moderate hypertriglyceridemia (triglycerides of 150–999 mg/dL) should be diagnosed to aid in the evaluation of cardiovascular risk

Severe and very severe hypertriglyceridemia (triglycerides of > 1000 mg/dL) should be considered as a risk for pancreatitis

Patients with hypertriglyceridemia should be evaluated for secondary causes of hyperlipidemia

Patients with primary hypertriglyceridemia should be evaluated for a family history of dyslipidemia and cardiovascular disease

The task force also recommends that the treatment goal in patients with moderate hypertriglyceridemia be a non-HDL cholesterol level in agreement with National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) guidelines. Lifestyle therapy should be the initial treatment, followed by a combination of diet changes and drug therapy. And, in patients with severe or very severe hypertriglyceridemia, a fibrate should be used as a first-line agent.

"Severe and very severe hypertriglyceridemia increase the risk for pancreatitis, while mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease," the authors wrote. "Therefore, similar to the NCEP ATP III guidelines committee's recommendations, we recommend screening adults for hypertriglyceridemia as part of a fasting lipid panel at least every five years."

The task force consisted of Berglund, who was selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), five additional field experts, and a methodologist. The guidelines were reviewed and approved sequentially by the CGS, Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council.