Makindo Medical Notes

💡 Lipid disorders are broadly classified as: predominant hypercholesterolaemia, predominant hypertriglyceridaemia, and mixed lipid disorders.

🔎 About Hypertriglyceridaemia (HTG)

• Defined as elevated triglyceride (TG) levels in plasma.
• Increases risk of cardiovascular disease and, when severe, acute pancreatitis.
• Most cases are polygenic or secondary to lifestyle/illness.

🧬 Aetiology

• Genetic Causes:
  • Lipoprotein Lipase Deficiency: Rare AR disorder with massive TG rise.
  • Apolipoprotein C-II Deficiency: Similar to LPL deficiency.
  • Polygenic Hypertriglyceridaemia: Most common; multifactorial inheritance.
  • Familial Hypertriglyceridaemia: Inherited, moderate TG elevation.
• Secondary (Acquired) Causes:
  • Excess alcohol 🍺 and uncontrolled type 2 diabetes.
  • Obesity, poor diet, sedentary lifestyle.
  • Drugs: Thiazides, corticosteroids, oestrogens, antiretrovirals.

📊 Severity

• Moderate: 2.3 – 5 mmol/L
• Severe: 5 – 10 mmol/L
• Very Severe: >10 mmol/L ⚠️ pancreatitis risk rises sharply >12 mmol/L

⚡ Causes by Pattern

• Acquired: Alcohol, uncontrolled diabetes, drugs.
• Familial:
  • Familial Combined Hyperlipidaemia: TG ± LDL raised.
  • Remnant Dyslipidaemia: TG + cholesterol elevated.
  • Chylomicronaemia Syndrome: Grossly raised TG, turbid plasma.

🩺 Clinical Features

• Pancreatitis: Major complication when TG very high.
• Lipaemia Retinalis 👁️: Milky retinal vessels in extreme TG rise.
• Hepatosplenomegaly: Due to lipid infiltration.
• Eruptive Xanthomas: Red–yellow papules on back/buttocks with severe HTG.
• Massive HTG: Seen in LPL deficiency from childhood.

💊 Management

• Risk assessment: Treat cardiovascular risk factors (smoking, diabetes, hypertension) alongside TG lowering.
• Medications:
  • Fibrates: 🔑 first-line; ↑ lipoprotein lipase activity.
  • Nicotinic Acid (Niacin): ↓ TG and LDL, ↑ HDL (less used now due to side effects).
  • Omega-3 fatty acids (fish oil): High dose can ↓ TG significantly.
• Lifestyle: Low-fat balanced diet 🥗, exercise 🏃, weight loss, reduce alcohol.

📌 Exam Tips

• Think pancreatitis when TG >12 mmol/L.
• FH = cholesterol; LPL deficiency = sky-high triglycerides.
• Fibrates are the pharmacological mainstay for HTG.