Source: DGNews  |  Posted 8 years ago

By Eurona Earl Tilley

KYOTO, JAPAN -- October 3, 2003 -- A researcher recommended a 4-part intensive treatment regimen for severe hypertriglyceridaemia (SHTG) during a presentation here on October 1st at the 13th International Symposium on Atherosclerosis.

Dr. H.U. Klor, 3rd Medical Department, University Hospital Glessen, and Working Group on Severe Hyperlipidaemia, German Lipid League, Glessen, Germany, said that patients with SHTG should first be treated with several courses of apheresis using a cascade filtration system until their plasma triglyceride levels decrease to below 500 mg/dL. "This should be followed by administration of an omega-3 medium chain fatty acid-based formula, long-term treatment with fish oil capsules in combination with a fibrate or nicotinic acid, and regular self-monitoring of triglyceride levels using a finger stick," he said.

Individuals with SHTG have a serum triglyceride level of about 1000 mg/dL. Dr. Klor explained that although most medical professionals believe SHTG to be easy to treat with fasting and drug therapy, and to cause no cardiovascular risk, special focus should be directed towards this disorder, because it is more common that currently believed.

He said that SHTG is generally accepted to be a rare lipid disorder that occurs in alcoholic males, and is associated with acute pancreatitis. However, his team's research indicates that prevalence of SHTG in Western Europe is in the order of 1:500 to 1:800. In a study involving 11 lipid centres and 326 SHTG patients from Germany, Austria, and Switzerland, Dr. Klor found that 90% of participants were non-alcoholics. There is a regional clustering of this disorder in Western countries due to genetic clustering.

Among the study participants, 31% had diabetes and 21% had pancreatitis. In contrast to the general medical opinion, 24% had atherosclerotic cardiovascular disease including 12% peripheral vascular disease and coronary heart disease.

Despite the long term treatment of these patients, most still had grossly abnormal lipid profiles -- serum triglyceride levels between 1000 and 5000 mg/dL and total cholesterol between 400 and 1000 mg/dL.

These findings encouraged Dr. Klor to take a new approach to treating SHTG. Following a 1-week course of omega-3 medium chain fatty acid based formula, the plasma triglyceride levels decreased by 61%. "However, plasma triglyceride level still remained suboptimal," he said. He therefore used an apheresis technique to eliminate the bulk of triglyceride rich lipoproteins in blood. Dr. Klor suggested that in managing SHTG patients, apheresis should be done first to decrease the plasma triglyceride levels below 500 mg/dL, followed by use of the omega-3 medium chain fatty acid based formula.

In closing, Dr. Klor stressed that SHTG is a life-threatening disorder that should be aggressively treated and managed.

[Study title: Severe Chylomicronemia: Clinical Epidemiology and Recommendations for Treatment. Abstract 3P-0788]