Triglycerides are fats that are accumulated in the body, in particular in adipose and muscle tissue, with reserve functions and hydrolyzed to obtain fatty acids and glycerol , with the release of energy. The concentration of triglycerides in the blood is called triglyceridemia .
Hypertriglyceridemia is a condition in which the concentration of triglycerides in the blood is above the norm. High triglycerides are a dyslipidemia , a pathological metabolic condition in which the concentration in the plasma of very low density lipoproteins ( VLDL , Very Low Density Lipoproteins) and chylomicrons are higher than normal. So, this condition involves the deposition of fats in the arteries and capillaries of numerous systems, with important consequences.
The triglycerides may be higher of the norm both in adults than in children. However, in itself, the condition does not generate symptoms, at least when dyslipidemia does not exceed a certain threshold of severity, causing serious disturbances. In fact, it is a risk factor for cardiovascular disease and acute pancreatitis , a potentially fatal disease.
Frequently hypertriglyceridemia is diagnosed by chance, following checks carried out for other reasons. Therefore, the first line of treatment consists in modifying the person ‘s lifestyle , eliminating from the diet the foods that increase the concentration of triglycerides in the blood , alcohol included, and further risk factors, such as cigarette smoking.
In addition, aerobic exercise allows you to maintain normal body weight and control the share of abdominal fat.
High triglycerides: what it means
During their stay in the bloodstream, triglycerides (lipophils) travel coated with special proteins ( apoproteins ) and transported by two types of lipoproteins:
- chylomicrons : they are the largest lipoproteins and contain different types of apoproteins (apo A-1, apo B, apo C, apo E)
- VLDL (Very Low Density Lipoproteins, very low density lipoproteins): they also contain a share of cholesterol.
In the muscles and adipose tissue both the chylomicrons and the VLDL loaded with triglycerides are split by a specific enzyme (lipoprotein lipase, LPL ) to obtain energy.
Hypertriglyceridemia: what it is
Hypertriglyceridemia is a pathological metabolic condition rather widespread in which the levels of triglycerides in the blood are higher than the normal range. In the subject, with high triglycerides , the concentration of very low density lipoproteins (VLDL) and chylomicrons is high in the plasma.
The triglycerides circulating in the plasma are of both exogenous origin (i.e. originating from food and transported within the chylomicrons) and enodgenic (synthesized by the liver and transported in the VLDL). In muscles and adipose tissue, lipoproteins loaded with triglycerides (both chylomicrons and VLDL) are hydrolyzed by LPL to free fatty acids.
Therefore, the concentration of triglycerides in the blood is part of a continuous (not discrete) scale and oscillates within even relatively wide ranges of values.
The dosage of the same person ‘s triglyceridemia can vary by 25% from one day to the next and rises rapidly following a meal.
Values of triglycerides
For these reasons, it is not possible to identify a normal level of triglycerides. parameters useful for diagnostic purposes are identified on the basis of clinical risk. The complexity in the classification of hypertriglyceridemia makes the diagnostic process challenging.
Then, based on the clinical risk, a triglyceridemia is identified :
- normal, if less than 175 mg / dL;
- mild: between 175-885 mg / dL;
- severe: above 885 mg / dL.
Levels of triglycerides greater than 900 or 1000 are generally typical of genetic causes, particularly from conditions such as familial hypertriglyceridemia and familial hyperchylomicronemia by lipoprotein lipase deficiency or apolipoprotein CII.
Triglycerides: primary and secondary causes
Although it is possible to distinguish briefly between primary and secondary causes of hypertriglyceridemia, most cases derive from the simultaneous presence of multiple factors.
Partial familial lipodystrophy (FPLD) is also among the genetic pathologies that determine primary hypertriglyceridemia .
This disease can be extremely resistant to drug therapy and easily cause episodes of acute pancreatitis.
family hypertriglyceridemia is an autosomal dominant disease that affects 2-3 people in 1000. This is an increase in blood triglycerides due to the accumulation of VLDL ( Frederickson type IV hypertriglyceridemia , less severe) or to the accumulation of VLDL and chylomicrons (more severe Frederickson type V hypertriglyceridemia associated with an increased risk of CHD).
The triglycerides are included between 200 and 500 mg / dL , but, in cases where other are concomitant risk factors (such as alcohol abuse or poor nutrition), can exceed 1,000 mg / dL .
This disease is expressed directly proportional to age, reaching the maximum level of manifestation between 50 and 60 years.
Generally there are no significant signs or symptoms, except in some cases in which it is possible to identify findings of hyperuricemia and early atherosclerosis . In addition, in order to control familial hypertriglyceridemia, a diet is administered, which must guarantee weight loss, and lipid-lowering drugs.
The disease affects 1 in 5,000 people and causes:
- the formation of xanthomas , especially tuberous and palmar
- the yellowish coloring of the palm folds
- premature coronary artery disease , that is, which appears before the age of 60.
Generally the concentration of triglycerides is between 250 and 500 mg / dL. Treatment involves dieting and taking lipid-lowering drugs.
Mixed or combined hyperlipidaemias
Much more frequent are mixed or combined hyperlipidaemias , conditions that involve increases in both cholesterol and triglycerides. In these cases, the co-presence of primary and secondary causes is necessary: it is therefore a pathology with a multifactorial genesis. It affects one in 50-100 people and can lead to premature coronary artery disease, responsible for approximately 15% of myocardial infarctions in people under 60.
The total cholesterol is maintained between 250 and 500 mg / dL and the triglycerides oscillate between 250 and 750 mg / dL .
In order to control this pathology, the patient must be on a diet , lose weight significantly and take lipid-lowering drugs .
Secondary causes of high triglycerides.
The secondary causes of hypertriglyceridemia (which justify 10-20% of cases) are represented by:
The insulin-dependent form of diabetes ( type I diabetes, IDDM, Insulin Dependent Diabetes Mellitus) involves a reduced ability of the lipoprotein lipase to metabolize triglycerides, breaking them down into fatty acids and glycerol with energy release. The non-insulin-dependent form ( type II diabetes, NIDDM , Non-Insuline Dependent Diabetes Mellitus) determines insulin resistance (i.e. a reduced effectiveness of insulin in allowing the entry of glucose into the cells and therefore the reduction of blood sugar) and therefore it increases production and reduces the catabolism of triglycerides.
Unhealthy eating habits
the sedentary lifestyle associated with an excessive intake of saturated fats, trans, sugars (which the body converts to triglycerides) and alcohol with diet is the main secondary cause of hypertriglyceridemia in the world. The trans fats are polyunsaturated or monounsaturated fatty acids which hydrogen atoms were added using industrial methods in order to saturate the double bonds; they are contained in many processed foods.
It is a condition characterized by the simultaneous presence of three metabolic and hemodynamic alterations and which represents a risk factor for the onset of cardiovascular diseases and tumors.
In addition, at least three conditions must be present for its diagnosis between:
increase in waist circumference (greater than 102 cm in men and 88 in women)
maximum (systolic) blood pressure above 130 mmHg and minimum (diastolic) pressure above 85
HDL cholesterol lower than 40 in men and 50 in women
triglyceridemia 150; blood sugar above 110 mg / dL.
The metabolic syndrome is caused by an incorrect lifestyle and a genetic predisposition, conditions that lead to the accumulation of abdominal fat , a phenomenon that can determine the onset of insulin resistance (at the base of diseases such as diabetes), of dyslipidemias and hypertension.
However, the metabolic syndrome does not generate particular symptoms and is also frequent in normal weight people.
Although a slight increase in triglycerides in pregnancy is considered physiological, it must still be monitored because it is potentially risky.
The main hormone secreted during gestation, progesterone, is characterized by anabolic, i.e. constructive, tissue functions. It has the task of activating in the mother’s organism the functions that allow the formation of the organs of the fetus.
Therefore, in this context, triglycerides play an important energy role and their level also increases. In risk cases, the detection of the mother’s lipid parameters during pregnancy allows to predict the possibility of complications such as gestosis or gestational diabetes mellitus, both conditions associated with hypertriglyceridemia.
Obesity and overweight are among the most important factors among those that create a predisposition to hypertriglyceridemia. Overweight is caused by an imbalance between the number of calories ingested and that of calories burned, in favor of the former, and is manifested by the accumulation of adipose tissue in the body, a phenomenon that occurs when triglycerides are high in the blood.
This is the reason why many of the prevention programs for hypertriglyceridemia and cardiovascular disorders are primarily aimed at obese subjects (with body mass index greater than 30 kg / m²), as well as, of course, those affected by type I or II diabetes.
The loss of thyroid function causes a reduction in the secretion of hormones that have an effect of activating the metabolism. Hence, the resulting metabolic slowdown can lead to a picture of hyperlipidemia.
chronic renal failure causes serious alterations in the lipid profile, because it disturbs the balance in the metabolism of VLDL.
In fact, this pathology is associated with a picture of early and accelerated atherosclerosis and with an increase in cardiovascular risk . The mechanism underlying this correlation is based on many factors (including the circulation of uremic toxins due to the weakening of the renal function, the increased oxidative stress, the state of chronic inflammation and hypertension) that lead to a deficit in catabolism of the VLDL, for marked reduction of lipolytic activity.
Nephrotic syndrome is caused by the alteration of the glomerular filtration barrier and involves loss of protein in the urine (proteinuria), which is associated with a general reduction in the amount of protein synthesized by the body, including those assigned to the catabolism of triglycerides. This aspect is responsible for the increase in blood triglyceride levels.
Cortisone drugs, cyclosporine (immunosuppressive drug), valproic acid (used to treat epilepsy), second generation antipsychotics, protease inhibitors used for the treatment of HIV infection and birth control pills are among the medicines responsible for increasing blood triglyceride levels .
Frequent motions are mixed or combined hyperlipidaemias , characterized by increases in both cholesterol and triglycerides.
High triglycerides: how they manifest
In themselves, high triglycerides do not cause symptoms, but can increase cardiovascular risk (in particular coronary artery disease , stroke and peripheral arterial disease ), acute pancreatitis , both symptomatic, and other minor manifestations such as:
- abdominal pain : they are typical of some genetic forms and associated with very high levels of triglycerides
- generalized fatigue : this symptom is also related to some primary causes of hypertriglyceridemia
- cognitive disorders : the increase in the viscosity of the blood due to the excess of triglycerides can reduce the blood circulation efficiency of some areas of the brain, with psychiatric consequences
- cutaneous xanthomas : when the level of triglycerides in the blood exceeds the normal threshold, these molecules are engulfed by cells that have a cleaning function, the macrophages (also called scavenger cells ). The accumulation of macrophages full of triglycerides (called foam cells , i.e. spongy-looking cells) at the skin level (of elbows, knees, hands, feet and buttocks) determines the formation of yellowish papules, called xanthomas . Xanthomas are called xanthelasms when they affect the eyelid. Xanthomas can be removed surgically, although they tend to reform
- hepatosplenomegaly : when triglycerides accumulate in the blood, they can settle in the liver and spleen tissue and recall the macrophages that have the task of incorporating and removing them; this phenomenon causes an enlargement of these two organs
- lipemia retinalis: the triglycerides high (greater than 2,000 mg / dL ) accumulate in the blood vessels of the retina; on observation of the eye with the ophthalmoscope the retinal vessels appear white.
Pathologies due to alterations of triglycerides
The most fearful complication of high triglycerides is acute pancreatitis, a very serious and potentially fatal clinical occurrence. In addition, high levels of triglycerides are associated with cardiovascular risk, with an increase in the probability of experiencing pathologies such as myocardial infarction, stroke and atherosclerosis.
The acute pancreatitis is a cause of hospital admissions and reduced productivity for days lost school or work. It reduces the quality of life, carries a risk of permanent organ damage and death.
High triglycerides are responsible for 1-4% of cases of acute pancreatitis: above 1,000 mg / dL the risk becomes real. Triglyceride values above 2,000 mg / dL are to be treated as a medical emergency.
Acute pancreatitis can be preceded by nausea , abdominal pain that radiates to the back and heartburn . In some patients also by an abnormal increase in pancreatic enzymes (especially lipases ).
The mechanism by which acute pancreatitis occurs is currently not well known. However, the excess of triglycerides also leads to an increased metabolism: the cleavage reaction with which they are hydrolyzed to release energy entails an increased production of fatty acids.
It is the accumulation of fatty acids in the pancreas that irritates this organ and triggers pancreatitis.
Acute pancreatitis: how to cure it
Although the signs of acute pancreatitis are not specific, the disease needs to be diagnosed and treated quickly. In patients with high triglycerides and other risk factors (decompensated diabetes, obesity, alcoholism) or in pregnancy, the presence of nausea, vomiting and intense abdominal pain should lead to suspicion of acute pancreatitis.
- aggressive hydration : the intake of large volumes of water reduces the secretion of proteins that carry triglycerides by the liver
- analgesia: acute pancreatitis causes very intense abdominal pain, which requires the administration of analgesics
- gastrointestinal rest : any dietary triglyceride intake must be avoided.
With these interventions it is possible to drastically and quickly reduce the levels of triglycerides: the goal is to bring them down to below 500 mg / dL.
Medical treatments such as plasmapheresis (replacement of plasma by connection to a machine in order to filter the triglycerides present) must be established within 48 hours of diagnosis, but insufficient data from the point of view of complications are available on this treatment.
Insulin is administered empirically , which activates the enzyme that metabolizes triglycerides (LPL) and reduces their level much more quickly than with plasmapheresis.
Heparin is also occasionally used , which produces the same effect, but which can determine, at a later time, a rebound of triglyceridemia and an increased risk of hemorrhagic pancreatitis .
As far as cardiovascular risk is concerned , experimental studies have revealed conflicting data on cardiovascular and cerebrovascular outcomes (stroke).
Since high triglycerides are almost always accompanied by the alteration of other lipid parameters in the blood, it is difficult to determine the influence of the individual components, how much is due to the action of triglycerides and as to the combined effect of cholesterol, triglycerides and lipoproteins .
Based on experimental findings, mild hypertriglyceridemia per se is a simple marker of cardiovascular risk. Therefore, in the case of moderate or severe forms, it is necessary to institute a therapy aimed at cardiovascular protection , based on the administration of statins, fibrates and pharmacological doses of omega-3 fatty acids.
Diagnosis of hypertriglyceridemia
The diagnosis of hypertriglyceridemia is important because even small deviations can increase the risk of complications.
Levels of triglycerides greater than 900 or 1,000 mg / dL are found in diseases causing hypertriglyceridemia that recognize genetic causes, in particular ‘ family hypertriglyceridemia and the’ family hyperchylomicronemia by lipoprotein lipase deficiency or apolipoprotein CII.
Therefore, those at risk are subjected to an analysis of the serum lipid profile, which includes:
- total cholesterol
- HDL cholesterol
- LDL cholesterol
Since the levels of triglycerides can fluctuate with a wide range during the day, it is necessary to undergo the sampling always on an empty stomach .
In addition, people at risk must undergo periodic monitoring of triglyceride levels , particularly if affected by inflammatory disease, because inflammation tends to increase them.
Thus, primary forms of hypertriglyceridemia are suspected when skin xanthomas are present in a subject with a history of early atherosclerotic disease (i.e., appearance at less than 60 years of age) or family history of atherosclerotic disorder and high levels of triglycerides .
Instead, as regards the diagnosis of secondary hypertriglyceridaemias , all the parameters related to one of the diseases that can be the cause of increased triglyceride levels are examined:
- fasting blood sugar
- liver enzymes
- thyroid hormones
High triglycerides: treatments
While the treatment of severe hypertriglyceridemia is not in question, the debate is open on the need to treat mild forms and above all on the real response to therapy. In fact, it has been observed that the administration of drugs capable of reducing the level of triglycerides (lipid-lowering agents) does not always produce appreciable cardiovascular results.
Furthermore, since high triglycerides are often accompanied by alterations in other blood lipid parameters, it is difficult to accurately attribute responsibilities in the genesis of any cardiovascular complications.
In general, the treatment of high triglycerides has two main objectives:
- prevention of acute pancreatitis (in severe cases, with triglycerides greater than 885 mg / dL )
- reduction of overall cardiovascular risk.
Finally, once the parameter has been normalized, the doctor should emphasize the importance of lifestyle , especially from the point of view of food and exercise.
The therapeutic approach starts from the treatment of any secondary factors present and from the lifestyle correction, to switch to drugs in cases where the diet has not produced results.
When lifestyle correction is insufficient and triglycerides remain above 200 mg / dL drug therapy should be prescribed.
The fibrates , particularly fenofibrate , are the first-line treatment for high triglycerides and are aimed at reducing the risk of pancreatitis and cardiovascular disease.
Some studies conducted on subjects in therapy show that fibrate therapy reduces major cardiovascular events by 13%, particularly in patients with high triglycerides , compared to good tolerability.
However, the most frequent side effect due to fibrates is myopathy (muscle damage). So, to avoid this risk, it is advisable to monitor muscle parameters with regular blood tests .
nicotinic acid reduces the production by the liver of one of two types of proteins that transport triglycerides in the blood (VLDL). At a dosage of 2 g / day it reduces the triglycerides by about 20-40%. It can give dermatological reactions, which sometimes limit the dosage.
The statins are drugs used to lower cholesterol: are prescribed in case of high triglycerides if your cholesterol is in excess. These drugs have been shown to significantly reduce mortality from lipid imbalances in the blood ( hyperlipidaemias ). In particular, atorvastatin , rosuvastatin , pitavastatin are used .
The combination of fibrates and statins produces a better overall action than monotherapy, but carries an additional risk of myopathy, which can be bypassed by advising the patient to take fibrates in the morning and statins in the evening.
However, in diabetic patients it is advisable to periodically update the insulin dosage , in order to better control the disease.
Omega 3 fatty acids
The fatty acids omega-3 ( PUFA ), namely eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ), are prescribed as an adjuvant therapy to pharmacological doses, comprised between 2 and 4 g / day . At these doses, they are able to significantly reduce triglyceridemia .
They can be added to the combined therapy of statins and fibrates.
However, the role of PUFAs is controversial.
In fact, some international studies have failed to demonstrate and quantify its beneficial effect in patients with metabolic pathology, while others have highlighted its important role in reducing cardiovascular risk in patients with high triglycerides treated with statins.
Therefore, further extensive studies are currently underway which will hopefully attribute an exact dimension to the role of omega-3s in the prevention of cardiovascular risk.
The Volanesorsen is an antisense oligonucleotide which produces a drop in triglycerides aimed to significantly reduce the risk of acute pancreatitis.
It was approved in 2019 after the Approach experimental study , which involved 66 patients in 40 different treatment centers, in 12 countries. It has shown that the use of this drug in most patients lowers triglyceride levels below the risk level for acute pancreatitis.
In addition, Volanesorsen is the only approved treatment for FCS .
Drugs for Multifactorial Familial Hyperkylomicronemia Syndrome (MFCS)
The syndrome familial hyperchylomicronemia multifactorial (MFCS) is more widespread than the other forms of FCS and may occur in patients suffering from diabetes or subjected, in the presence of a specific genetic predisposition, therapy with certain drugs, such as:
- beta blockers
- thiazide and loop diuretics, such as furosemide
- retinoids, such as those used for acne treatment
- estrogens, prescribed for anticonventional purposes or for menopause replacement therapy
- raloxifene, an estrogen receptor modulator that is used to treat some types of cancer or osteoporosis
- protease inhibitors, used for AIDS therapy;
If diabetes is co-present, it must be adequately controlled, as well as all drugs that can help raise triglyceride levels (compatibly with the possibility of replacing them with other molecules).
Furthermore, alcohol must be eliminated and a reduction in body weight must be achieved , with maintenance at satisfactory levels and the prevention of any rebound effects, which lead the patient to accumulate kilos after losing them. Instead, in the most difficult cases, you can resort to surgery bariatric .
However, if triglycerides remain high despite these interventions, your doctor may prescribe medications such as:
- omega-3 fatty acids
Volanesorsen has recently been approved , a drug that allows a reduction in triglyceride levels in order to counteract the risk of acute pancreatitis, the most fearful complication of hypertriglyceridemia .
It is the only treatment approved for FCS, consisting of an antisense oligonucleotide , that is, a construct that allows the cell to bypass the genetic error and produce a protein that is at least partially functional.
Antisense oligonucleotides are the new frontier of biotechnology for the treatment of rare genetic diseases .
Diet for high triglycerides
The lifestyle is the first parameter on which it intervenes in the presence of hypertriglyceridemia mild or moderate, bearing in mind that in patients with very high triglycerides is necessary to establish an immediate drug treatment.
G interventions them on lifestyle can also reduce triglycerides by 25-30%.
What not to eat
The concentration of triglycerides in the blood depends to a large extent on the diet , in particular on the intake of simple sugars and alcohol , substances that are converted into triglycerides destined for accumulation in the body.
Alcohol in particular must be completely eliminated in cases of severe hypertriglyceridemia.
While the trans fat are linked to increased levels of triglycerides in the blood. In fact, they are unsaturated fatty acids (those that do not derive from animal sources) that have been saturated through industrial processes for the preparation of ready- to- eat foods , foods to be avoided as part of a balanced diet.
What to eat
If on the one hand, the nutrition of those who must keep triglycerides under control must deplete saturated fats (those of animal origin), on the other it should be enriched with mono- and polyunsaturated fats , including those of the omega-3 line .
People with hypertriglyceridemia should keep body weight within certain limits, particularly by focusing on abdominal fat . In fact, the deposition of abdominal fat represents an additional risk factor for cardiovascular pathology, even when associated with a normal body weight.
Therefore, the reduction of calorie intake should be part of a balanced food framework established with a nutritionist , so as not to take precious substances away from the body. The real goal is not to achieve a healthy weight, but to maintain it over time; it is not the temporary adoption of measures to dispose of fat, but their transformation into lifestyle.
In this perspective, it is possible to identify universally valid indications to define an adequate diet for the purpose, although the actual diet plan must be the result of a personalized strategy , tailored to the individual.
Fruits and vegetables
It is better to limit the presence of fruit , rich in sugars, in particular very sweet ones, such as persimmons , bananas , figs and grapes .
Green light for the consumption of vegetables , with a clarification: carrots and potatoes are not vegetables, but very sugar-rich vegetables, which must be considered as pasta, bread and rice. The latter must be chosen in the integral version , rich in fiber and therefore with a lower intake of sugars and with a reduction action of the intestinal absorption of sugars and fats.
It is useful to read the label of the foods purchased: avoid ready – made foods (generally processed and therefore rich in trans fats), in favor of simple foods that can be cooked quickly with few condiments. And always check that there are no added sugars in the products you intend to buy.
Which meats and cheeses to choose in case of high triglycerides
Opting for low-fat milk and yogurt , low-fat cuts of meat , limiting (strictly low- fat) cheeses to twice a week, and using olive oil (in thrifty quantities) instead of butter helps to contain the amount of saturated fat ingested.
Sorbing tea, coffee and herbal teas without sugar allows you to fully enjoy the flavor and reduce the caloric intake.
Yes to spices
The Mediterranean scrub is known for its heady shrubs: we take a cue to add aroma and flavor to the table. The wide use of spices allows to reduce the quantity of oil and salt used to flavor the food and to obtain a functional action .
Just think of turmeric , cumin and chili pepper (rich in antioxidants) and fennel seeds (rich in anethole, which promotes digestion and helps reduce intestinal fermentations) and ginger gingerol , with its marked anti-inflammatory activity.
Which fish to eat in case of high triglycerides
The fish, rich in omega-3 fatty acids (in particular the blue fish with which our seas are so rich), must be consumed at least three times a week.
For those used to an aperitif , it can be difficult to give up alcoholic drinks. One idea is to try replacing them with fruit-based non-alcoholic cocktails, centrifuged or, occasionally, with light carbonated drinks. The juices are not recommended, because they are rich in sugar, even when free of added sugars.
Of course, sweets, cakes, biscuits, ice cream and sorbets, even if produced with soy , are among the foods to be banned . In this case, in fact, the saturated fat component is eliminated, but not the sugar component.
Sports and high triglycerides
Physical activity plays a central role in the normalization of triglyceride levels in the blood , also through the reduction of body weight and the maintenance of the achieved weight.
For this purpose, it is necessary to choose an aerobic sport , in which oxygen represents the comburent used by muscle cells to obtain energy. Aerobic physical activity has been shown to have an effect on the concentration of lipids in the blood, in particular on the concentration of triglycerides .
While anaerobic exercise leads to the accumulation of lactic acid and produces a feeling of fatigue, which shortens sports activity and requires much longer recovery times, aerobic physical activity metabolizes fatty acids more efficiently, which are thus removed from the accumulation in the form of triglycerides.
Therefore, preferring endurance sports , which require breath, such as running and swimming over long distances , allows to reduce triglycerides.
When triglycerides are very high, the risk of acute pancreatitis requires more drastic therapies, such as therapeutic plasmapheresis. In fact, this treatment consists in removing the plasma and passing it inside a machine that removes the fats and returns it to the body. This is not a routine procedure, also because of the possible consequences that it can determine, which are not completely known.
Gene therapy is likely to be applicable in cases where high triglycerides are due to a primary genetic cause. If a monogenic mutation (which affects only one gene) is present at the basis of the pathology, this can be corrected by inserting the correct gene in the DNA. In the past, gene therapy with associated adeno virus (alipogene tiparvovec) has been used for this purpose, which is no longer available.
Therefore, in cases where diet and exercise do not produce appreciable results in terms of weight loss, it can be assumed to resort to bariatric surgery, with the realization of gastric bypass to reduce the absorption of nutrients.
High triglycerides: prevention
Regarding the prevention of complications, the patient must observe the indications of the doctor, in terms of correcting his lifestyle and taking, where necessary, appropriate pharmacological therapies.
The prevention of hypertriglyceridemia is based on the adoption of correct eating habits , on the regular execution of an aerobic physical activity , on the renunciation of cigarette smoking and alcohol . In addition to the treatment of conditions that can determine that, when secondary, such as diabetes, the metabolic syndrome, the ‘ obesity, ‘ s hypothyroidism, any kidney disease (chronic renal failure, and nephrotic syndrome).
The importance of nutrition
The diet must be depleted of simple sugars , which are converted in the body into triglycerides destined for the accumulation, of trans fats contained in processed foods and limited in the consumption of fruit (in particular the sugary one, such as persimmons, bananas, figs and grapes). The diet must instead be enriched with mono- and polyunsaturated fats , including those of the omega-3 line , fish (especially blue fish) and vegetables.
Better to choose whole grains , low-fat dairy products , olive oil and increase the use of spices , which perfume the dishes and flavor them without adding calories.
Keeping body weight within certain limits, in particular by focusing on abdominal fat, helps to reduce the risk of triglycerides increasing.
Finally, it should also be remembered that soy products , if sweet, do not reduce the risk: in this case, in fact, the saturated fat component is eliminated, but not the sugar component.
Volanesorsen and triglyceride levels in familial Chylomicronemia Syndrome – JL Witztum et al –New England Journal of Medicine, 2019 ;
Dyslipidemia in chronic kidney disease – P. Cappelli – Trends in Medicine, 2007 .