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Hypertriglyceridemia

Authors
Robert S Rosenson, MD
John JP Kastelein, MD, PhD, FESC
Section Editor
Mason W Freeman, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Hypertriglyceridemia is most often identified in individuals who have had a lipid profile as part of cardiovascular risk assessment. (See "Screening for lipid disorders in adults", section on 'Choice of tests' and "Estimation of cardiovascular risk in an individual patient without known cardiovascular disease" and "Overview of the risk equivalents and established risk factors for cardiovascular disease", section on 'Lipids and lipoproteins'.)

This topic reviews the evidence that hypertriglyceridemia contributes to the development of adverse cardiovascular events, the mechanisms by which this might occur, the disorders of triglyceride metabolism that have been identified, and recommendations for the management of hypertriglyceridemia. The pathways involved in triglyceride synthesis and metabolism are discussed separately. (See "Lipoprotein classification, metabolism, and role in atherosclerosis", section on 'Endogenous pathway of lipid metabolism'.) The management of patients with hypertriglyceridemia who have acute or prior pancreatitis is also discussed separately. (See "Hypertriglyceridemia-induced acute pancreatitis".)

INDICATIONS FOR MEASUREMENT

The indications for the measurement of serum triglyceride are presented separately. (See "Measurement of blood lipids and lipoproteins", section on 'Indications for measurement'.)

DEFINITION AND PREVALENCE

One widely used definition of hypertriglyceridemia is described in a table (table 1). The serum triglyceride concentration can be stratified in terms of population percentiles and/or coronary risk [1]:

Normal – <150 mg/dL (1.7 mmol/L)

                   

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Literature review current through: Feb 2017. | This topic last updated: Tue Feb 28 00:00:00 GMT+00:00 2017.
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References
Top
  1. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106:3143.
  2. Stroes E, Moulin P, Parhofer KG, et al. Diagnostic algorithm for familial chylomicronemia syndrome. Atheroscler Suppl 2017; 23:1.
  3. Ford ES, Li C, Zhao G, et al. Hypertriglyceridemia and its pharmacologic treatment among US adults. Arch Intern Med 2009; 169:572.
  4. Genest JJ Jr, Martin-Munley SS, McNamara JR, et al. Familial lipoprotein disorders in patients with premature coronary artery disease. Circulation 1992; 85:2025.
  5. Ginsberg HN. Hypertriglyceridemia: new insights and new approaches to pharmacologic therapy. Am J Cardiol 2001; 87:1174.
  6. Assmann G, Schulte H, von Eckardstein A. Hypertriglyceridemia and elevated lipoprotein(a) are risk factors for major coronary events in middle-aged men. Am J Cardiol 1996; 77:1179.
  7. Ballantyne CM, Grundy SM, Oberman A, et al. Hyperlipidemia: diagnostic and therapeutic perspectives. J Clin Endocrinol Metab 2000; 85:2089.
  8. Hodis HN, Mack WJ. Triglyceride-rich lipoproteins and the progression of coronary artery disease. Curr Opin Lipidol 1995; 6:209.
  9. Mack WJ, Krauss RM, Hodis HN. Lipoprotein subclasses in the Monitored Atherosclerosis Regression Study (MARS). Treatment effects and relation to coronary angiographic progression. Arterioscler Thromb Vasc Biol 1996; 16:697.
  10. Hodis HN, Mack WJ, Dunn M, et al. Intermediate-density lipoproteins and progression of carotid arterial wall intima-media thickness. Circulation 1997; 95:2022.
  11. Jukema JW, van Boven AJ, Groenemeijer B, et al. The Asp9 Asn mutation in the lipoprotein lipase gene is associated with increased progression of coronary atherosclerosis. REGRESS Study Group, Interuniversity Cardiology Institute, Utrecht, The Netherlands. Regression Growth Evaluation Statin Study. Circulation 1996; 94:1913.
  12. Thompson WG, Gau GT. Hypertriglyceridemia and its pharmacologic treatment among US adults--invited commentary. Arch Intern Med 2009; 169:578.
  13. Rosenson RS, Davidson MH, Hirsh BJ, et al. Genetics and causality of triglyceride-rich lipoproteins in atherosclerotic cardiovascular disease. J Am Coll Cardiol 2014; 64:2525.
  14. Triglyceride Coronary Disease Genetics Consortium and Emerging Risk Factors Collaboration, Sarwar N, Sandhu MS, et al. Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet 2010; 375:1634.
  15. Pare G, Anand SS. Mendelian randomisation, triglycerides, and CHD. Lancet 2010; 375:1584.
  16. Dewey FE, Gusarova V, O'Dushlaine C, et al. Inactivating Variants in ANGPTL4 and Risk of Coronary Artery Disease. N Engl J Med 2016; 374:1123.
  17. Myocardial Infarction Genetics and CARDIoGRAM Exome Consortia Investigators, Stitziel NO, Stirrups KE, et al. Coding Variation in ANGPTL4, LPL, and SVEP1 and the Risk of Coronary Disease. N Engl J Med 2016; 374:1134.
  18. Kersten S. The Genetics of Dyslipidemia--When Less Is More. N Engl J Med 2016; 374:1192.
  19. Holmes MV, Asselbergs FW, Palmer TM, et al. Mendelian randomization of blood lipids for coronary heart disease. Eur Heart J 2015; 36:539.
  20. Sarwar N, Danesh J, Eiriksdottir G, et al. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies. Circulation 2007; 115:450.
  21. Tirosh A, Rudich A, Shochat T, et al. Changes in triglyceride levels and risk for coronary heart disease in young men. Ann Intern Med 2007; 147:377.
  22. Haim M, Benderly M, Brunner D, et al. Elevated serum triglyceride levels and long-term mortality in patients with coronary heart disease: the Bezafibrate Infarction Prevention (BIP) Registry. Circulation 1999; 100:475.
  23. Sprecher DL, Pearce GL, Cosgrove DM, et al. Relation of serum triglyceride levels to survival after coronary artery bypass grafting. Am J Cardiol 2000; 86:285.
  24. Bansal S, Buring JE, Rifai N, et al. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007; 298:309.
  25. Freiberg JJ, Tybjaerg-Hansen A, Jensen JS, Nordestgaard BG. Nonfasting triglycerides and risk of ischemic stroke in the general population. JAMA 2008; 300:2142.
  26. Wittrup HH, Tybjaerg-Hansen A, Nordestgaard BG. Lipoprotein lipase mutations, plasma lipids and lipoproteins, and risk of ischemic heart disease. A meta-analysis. Circulation 1999; 99:2901.
  27. Sprecher DL, Harris BV, Stein EA, et al. Higher triglycerides, lower high-density lipoprotein cholesterol, and higher systolic blood pressure in lipoprotein lipase-deficient heterozygotes. A preliminary report. Circulation 1996; 94:3239.
  28. Hypertriglyceridaemia and vascular risk. Report of a meeting of physicians and scientists, University College London Medical School. Lancet 1993; 342:781.
  29. Miller M, Seidler A, Moalemi A, Pearson TA. Normal triglyceride levels and coronary artery disease events: the Baltimore Coronary Observational Long-Term Study. J Am Coll Cardiol 1998; 31:1252.
  30. Gaziano JM, Hennekens CH, O'Donnell CJ, et al. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation 1997; 96:2520.
  31. Manninen V, Tenkanen L, Koskinen P, et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation 1992; 85:37.
  32. Horowitz BS, Goldberg IJ, Merab J, et al. Increased plasma and renal clearance of an exchangeable pool of apolipoprotein A-I in subjects with low levels of high density lipoprotein cholesterol. J Clin Invest 1993; 91:1743.
  33. Lamarche B, Uffelman KD, Carpentier A, et al. Triglyceride enrichment of HDL enhances in vivo metabolic clearance of HDL apo A-I in healthy men. J Clin Invest 1999; 103:1191.
  34. Föger B, Ritsch A, Doblinger A, et al. Relationship of plasma cholesteryl ester transfer protein to HDL cholesterol. Studies in normotriglyceridemia and moderate hypertriglyceridemia. Arterioscler Thromb Vasc Biol 1996; 16:1430.
  35. Miller BD, Alderman EL, Haskell WL, et al. Predominance of dense low-density lipoprotein particles predicts angiographic benefit of therapy in the Stanford Coronary Risk Intervention Project. Circulation 1996; 94:2146.
  36. Brunzell JD. Clinical practice. Hypertriglyceridemia. N Engl J Med 2007; 357:1009.
  37. Stampfer MJ, Krauss RM, Ma J, et al. A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA 1996; 276:882.
  38. Lamarche B, Tchernof A, Mauriège P, et al. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA 1998; 279:1955.
  39. Zilversmit DB. Atherogenesis: a postprandial phenomenon. Circulation 1979; 60:473.
  40. Fukushima H, Kugiyama K, Sugiyama S, et al. Comparison of remnant-like lipoprotein particles in postmenopausal women with and without coronary artery disease and in men with coronary artery disease. Am J Cardiol 2001; 88:1370.
  41. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14:173.
  42. McLaughlin T, Abbasi F, Cheal K, et al. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med 2003; 139:802.
  43. Simpson HC, Mann JI, Meade TW, et al. Hypertriglyceridaemia and hypercoagulability. Lancet 1983; 1:786.
  44. Humphries SE, Lane A, Green FR, et al. Factor VII coagulant activity and antigen levels in healthy men are determined by interaction between factor VII genotype and plasma triglyceride concentration. Arterioscler Thromb 1994; 14:193.
  45. Rosenson RS, Shott S, Lu L, Tangney CC. Hypertriglyceridemia and other factors associated with plasma viscosity. Am J Med 2001; 110:488.
  46. Mora S, Otvos JD, Rosenson RS, et al. Lipoprotein particle size and concentration by nuclear magnetic resonance and incident type 2 diabetes in women. Diabetes 2010; 59:1153.
  47. Mackey RH, Mora S, Bertoni AG, et al. Lipoprotein particles and incident type 2 diabetes in the multi-ethnic study of atherosclerosis. Diabetes Care 2015; 38:628.
  48. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67:968.
  49. O'Brien T, Nguyen TT, Zimmerman BR. Hyperlipidemia and diabetes mellitus. Mayo Clin Proc 1998; 73:969.
  50. Smellie WS. Hypertriglyceridaemia in diabetes. BMJ 2006; 333:1257.
  51. Wheeler DC, Bernard DB. Lipid abnormalities in the nephrotic syndrome: causes, consequences, and treatment. Am J Kidney Dis 1994; 23:331.
  52. Appel G. Lipid abnormalities in renal disease. Kidney Int 1991; 39:169.
  53. O'Brien T, Dinneen SF, O'Brien PC, Palumbo PJ. Hyperlipidemia in patients with primary and secondary hypothyroidism. Mayo Clin Proc 1993; 68:860.
  54. Walsh BW, Schiff I, Rosner B, et al. Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins. N Engl J Med 1991; 325:1196.
  55. Glueck CJ, Lang J, Hamer T, Tracy T. Severe hypertriglyceridemia and pancreatitis when estrogen replacement therapy is given to hypertriglyceridemic women. J Lab Clin Med 1994; 123:59.
  56. Crook D, Cust MP, Gangar KF, et al. Comparison of transdermal and oral estrogen-progestin replacement therapy: effects on serum lipids and lipoproteins. Am J Obstet Gynecol 1992; 166:950.
  57. Hozumi Y, Kawano M, Saito T, Miyata M. Effect of tamoxifen on serum lipid metabolism. J Clin Endocrinol Metab 1998; 83:1633.
  58. Fonarow GC, Deedwania P, Fonseca V, et al. Differential effects of extended-release carvedilol and extended-release metoprolol on lipid profiles in patients with hypertension: results of the Extended-Release Carvedilol Lipid Trial. J Am Soc Hypertens 2009; 3:210.
  59. Kasiske BL, Ma JZ, Kalil RS, Louis TA. Effects of antihypertensive therapy on serum lipids. Ann Intern Med 1995; 122:133.
  60. Berg AL, Nilsson-Ehle P. ACTH lowers serum lipids in steroid-treated hyperlipemic patients with kidney disease. Kidney Int 1996; 50:538.
  61. Hilbrands LB, Demacker PN, Hoitsma AJ, et al. The effects of cyclosporine and prednisone on serum lipid and (apo)lipoprotein levels in renal transplant recipients. J Am Soc Nephrol 1995; 5:2073.
  62. Feeney ER, Mallon PW. HIV and HAART-Associated Dyslipidemia. Open Cardiovasc Med J 2011; 5:49.
  63. Greenberg BH, Blackwelder WC, Levy RI. Primary type V hyperlipoproteinemia. A descriptive study in 32 families. Ann Intern Med 1977; 87:526.
  64. Ghiselli G, Schaefer EJ, Zech LA, et al. Increased prevalence of apolipoprotein E4 in type V hyperlipoproteinemia. J Clin Invest 1982; 70:474.
  65. Santamarina-Fojo S. The familial chylomicronemia syndrome. Endocrinol Metab Clin North Am 1998; 27:551.
  66. Benlian P, De Gennes JL, Foubert L, et al. Premature atherosclerosis in patients with familial chylomicronemia caused by mutations in the lipoprotein lipase gene. N Engl J Med 1996; 335:848.
  67. Nordestgaard BG, Abildgaard S, Wittrup HH, et al. Heterozygous lipoprotein lipase deficiency: frequency in the general population, effect on plasma lipid levels, and risk of ischemic heart disease. Circulation 1997; 96:1737.
  68. http://www.bbc.co.uk/news/health-20179561 (Accessed on November 19, 2012).
  69. Gaudet D, Brisson D, Tremblay K, et al. Targeting APOC3 in the familial chylomicronemia syndrome. N Engl J Med 2014; 371:2200.
  70. Austin MA, McKnight B, Edwards KL, et al. Cardiovascular disease mortality in familial forms of hypertriglyceridemia: A 20-year prospective study. Circulation 2000; 101:2777.
  71. Mahley RW, Huang Y, Rall SC Jr. Pathogenesis of type III hyperlipoproteinemia (dysbetalipoproteinemia). Questions, quandaries, and paradoxes. J Lipid Res 1999; 40:1933.
  72. Walden CC, Hegele RA. Apolipoprotein E in hyperlipidemia. Ann Intern Med 1994; 120:1026.
  73. Huang Y, Rall SC Jr, Mahley RW. Genetic factors precipitating type III hyperlipoproteinemia in hypolipidemic transgenic mice expressing human apolipoprotein E2. Arterioscler Thromb Vasc Biol 1997; 17:2817.
  74. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 1995; 90:2134.
  75. Gotto AM Jr. Hypertriglyceridemia: risks and perspectives. Am J Cardiol 1992; 70:19H.
  76. Chait A, Brunzell JD. Chylomicronemia syndrome. Adv Intern Med 1992; 37:249.
  77. Pownall HJ, Ballantyne CM, Kimball KT, et al. Effect of moderate alcohol consumption on hypertriglyceridemia: a study in the fasting state. Arch Intern Med 1999; 159:981.
  78. Lloret Linares C, Pelletier AL, Czernichow S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas 2008; 37:13.
  79. Sandhu S, Al-Sarraf A, Taraboanta C, et al. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis 2011; 10:157.
  80. Lederle FA, Bloomfield HE. Drug treatment of asymptomatic hypertriglyceridemia to prevent pancreatitis: where is the evidence? Ann Intern Med 2012; 157:662.
  81. Keech A, Simes RJ, Barter P, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366:1849.
  82. Bezafibrate Infarction Prevention (BIP) study. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease. Circulation 2000; 102:21.
  83. Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med 1987; 317:1237.
  84. Deedwania PC, Hunninghake DB, Bays HE, et al. Effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin on atherogenic dyslipidemia in patients with characteristics of the metabolic syndrome. Am J Cardiol 2005; 95:360.
  85. Hunninghake DB, Stein EA, Bays HE, et al. Rosuvastatin improves the atherogenic and atheroprotective lipid profiles in patients with hypertriglyceridemia. Coron Artery Dis 2004; 15:115.
  86. Bakker-Arkema RG, Davidson MH, Goldstein RJ, et al. Efficacy and safety of a new HMG-CoA reductase inhibitor, atorvastatin, in patients with hypertriglyceridemia. JAMA 1996; 275:128.
  87. Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 1999; 341:410.
  88. ACCORD Study Group, Ginsberg HN, Elam MB, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362:1563.
  89. Elam MB, Ginsberg HN, Lovato LC, et al. Association of Fenofibrate Therapy With Long-term Cardiovascular Risk in Statin-Treated Patients With Type 2 Diabetes. JAMA Cardiol 2016.
  90. Rosenson RS. Fenofibrate: treatment of hyperlipidemia and beyond. Expert Rev Cardiovasc Ther 2008; 6:1319.
  91. Adkins JC, Faulds D. Micronised fenofibrate: a review of its pharmacodynamic properties and clinical efficacy in the management of dyslipidaemia. Drugs 1997; 54:615.
  92. Capell WH, DeSouza CA, Poirier P, et al. Short-term triglyceride lowering with fenofibrate improves vasodilator function in subjects with hypertriglyceridemia. Arterioscler Thromb Vasc Biol 2003; 23:307.
  93. Magarian GJ, Lucas LM, Colley C. Gemfibrozil-induced myopathy. Arch Intern Med 1991; 151:1873.
  94. Miller DB, Spence JD. Clinical pharmacokinetics of fibric acid derivatives (fibrates). Clin Pharmacokinet 1998; 34:155.
  95. Pierce LR, Wysowski DK, Gross TP. Myopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy. JAMA 1990; 264:71.
  96. Athyros VG, Papageorgiou AA, Hatzikonstandinou HA, et al. Safety and efficacy of long-term statin-fibrate combinations in patients with refractory familial combined hyperlipidemia. Am J Cardiol 1997; 80:608.
  97. Ballantyne CM, Davidson MH. Possible differences between fibrates in pharmacokinetic interactions with statins. Arch Intern Med 2003; 163:2394.
  98. Rosenson RS. Current overview of statin-induced myopathy. Am J Med 2004; 116:408.
  99. Goldberg AC, Bays HE, Ballantyne CM, et al. Efficacy and safety of ABT-335 (fenofibric acid) in combination with atorvastatin in patients with mixed dyslipidemia. Am J Cardiol 2009; 103:515.
  100. Monk JP, Todd PA. Bezafibrate. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hyperlipidaemia. Drugs 1987; 33:539.
  101. Garg A, Grundy SM. Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus. JAMA 1990; 264:723.
  102. Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994; 121:252.
  103. Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: A randomized trial. Arterial Disease Multiple Intervention Trial. JAMA 2000; 284:1263.
  104. Grundy SM, Vega GL, McGovern ME, et al. Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial. Arch Intern Med 2002; 162:1568.
  105. Nestel PJ, Connor WE, Reardon MF, et al. Suppression by diets rich in fish oil of very low density lipoprotein production in man. J Clin Invest 1984; 74:82.
  106. Harris WS, Connor WE, Illingworth DR, et al. Effects of fish oil on VLDL triglyceride kinetics in humans. J Lipid Res 1990; 31:1549.
  107. Durrington PN, Bhatnagar D, Mackness MI, et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart 2001; 85:544.
  108. Harris WS, Ginsberg HN, Arunakul N, et al. Safety and efficacy of Omacor in severe hypertriglyceridemia. J Cardiovasc Risk 1997; 4:385.
  109. Ballantyne CM, Bays HE, Kastelein JJ, et al. Efficacy and safety of eicosapentaenoic acid ethyl ester (AMR101) therapy in statin-treated patients with persistent high triglycerides (from the ANCHOR study). Am J Cardiol 2012; 110:984.
  110. Bays HE, Ballantyne CM, Kastelein JJ, et al. Eicosapentaenoic acid ethyl ester (AMR101) therapy in patients with very high triglyceride levels (from the Multi-center, plAcebo-controlled, Randomized, double-blINd, 12-week study with an open-label Extension [MARINE] trial). Am J Cardiol 2011; 108:682.
  111. Lennertz A, Parhofer KG, Samtleben W, Bosch T. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Ther Apher 1999; 3:227.
  112. Gaudet D, Alexander VJ, Baker BF, et al. Antisense Inhibition of Apolipoprotein C-III in Patients with Hypertriglyceridemia. N Engl J Med 2015; 373:438.
  113. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:S1.
  114. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999.
  115. Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2969.