Spectrum and management of hypertriglyceridemia among children in clinical practice

Cedric Manlhiot, Per Larsson, Rebecca C. Gurofsky, Ryan W. Smith, Catherine Fillingham, Nadia A. Clarizia, Nita Chahal, Joseph T. Clarke, Brian W. McCrindle

Research output: Contribution to journalArticle

Abstract

OBJECTIVES. The prevalence and identification of hypertriglyceridemia in youths will likely will increase in the future as a consequence of childhood obesity and increased screening for dyslipidemias. We sought to review our clinical experience with hypertriglyceridemia, evaluate factors associated with increased triglyceride levels, and review treatment options to provide guidance for management. METHODS. Clinical review of data for all patients who had ≥ 1 elevated triglyceride level (>4 mmol/L [>350 mg/dL]) while being monitored in a specialized lipid disorders clinic was performed. RESULTS.The study population consisted of 76 patients with 761 clinic visits. Hyper- triglyceridemia was secondary to lifestyle factors for 13 patients. The rest had primary hypertriglyceridemia, with 32 patients having familial combined hypertriglyceride- mia and hypercholesterolemia (type II), 25 patients having primary hypertriglycer- idemia (type IV), 4 patients having familial lipase deficiency (type I), and 2 patients having hyperlipoproteinemia E2/E2 phenotype (type III). Triglyceride levels were highest in type I and III hypertriglyceridemia (>10 mmol/L [>900 mg/dL]), followed by type IV and adiposity-related hypertriglyceridemia ( > 4 mmol/L [ > 350 mg/dL]) and finally type II familial combined hypertriglyceridemia and hypercholesterolemia (>2 mmol/L [>180 mg/dL]). A total of 34 patients received 37 trials of drug therapy as part of triglyceride level management (bile acid-binding resins, n = 12;fibrates, n = 19;statins, n = 6). Triglyceride levels were found to decrease over time with the use of fibrates, to increase with the use of bile acid-binding resins, and not to change with the use of statins. CONCLUSIONS. Lifestyle modifications remain the primary therapeutic avenue for the management of pediatric hypertriglyceridemia. We propose an algorithm for the management of this heterogeneous population to guide clinicians in their treatment decisions.

Original languageEnglish (US)
Pages (from-to)458-465
Number of pages8
JournalPediatrics
Volume123
Issue number2
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

Keywords

  • Dyslipidemias
  • Hyperlipidemias
  • Pediatrics
  • Triglycerides

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Manlhiot, C., Larsson, P., Gurofsky, R. C., Smith, R. W., Fillingham, C., Clarizia, N. A., Chahal, N., Clarke, J. T., & McCrindle, B. W. (2009). Spectrum and management of hypertriglyceridemia among children in clinical practice. Pediatrics, 123(2), 458-465. https://doi.org/10.1542/peds.2008-0367