Severe Hypertriglyceridemia Managed Successfully in Primary care: A Pragmatic Clinical Observation
Mukti Nath Sankhi¹*, Rajkumar Thapa¹, Rajiv Sitaula¹, Sabin Rajbhandari¹, and Santosh Kumar Singh²
¹Nepalese Army Institute of Health Sciences College of Medicine, Kathmandu, Nepal
²Armed Forces Medical College, Pune, Maharashtra, India
*Corresponding Author: Mukti Nath Sankhi, Nepalese Army Institute of Health Sciences College of Medicine, Kathmandu, Nepal
DOI: 10.64258/3067-7130.2026.1020045.
Submission Date: April 25, 2026
Published Date: May 8, 2026
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Hypertriglyceridemia is defined by the National Cholesterol Education Program Adult Treatment Panel III as fasting blood plasma triglyceride (TG) levels ≥150 mg/dL. Various societies have given different classification of hypertriglyceridemia. Plasma TG level between 150 and 499 mg/dL are considered borderline to high, levels ≥ 500 mg/dL are classified as very high [1] . A subset of patients may develop “very severe hypertriglyceridemia,” which the Endocrine Society defines as a serum triglyceride concentration ≥2000 mg/dL [2]. TG levels exceeding 1,000 mg/dL are associated with increased risk of acute pancreatitis. Apart from this triglyceride-rich lipoproteins and elevated triglyceride levels are recognized as independent contributors to atherosclerotic cardiovascular disease, emphasizing the need for targeted management [3]. The etiology of very severe hypertriglyceridemia may be either primary (genetic) or secondary. Primary causes include biallelic mutations affecting Lipoprotein lipase (LPL), apolipoprotein C2 (APOC2), lipase maturation factor 1 (LMF1), apolipoprotein 5 (APOA5), and glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1). Patients with familial chylomicronemia syndrome or type 1 hyperlipoproteinemia typically harbor pathogenic mutations in these genes and often present at a younger age with recurrent acute pancreatitis. There are numerous etiologies of secondary hypertriglyceridemia that are more common and include uncontrolled diabetes mellitus, nephrotic syndrome, excessive alcohol use, and the use of certain medications such as protease inhibitors, vitamin A derivatives, l-asparaginase, and estrogen. Additional contributory factures include obesity, metabolic syndrome, chronic kidney disease, hypothyroidism, betablockers, thiazide diuretics, and estrogen containing preparations, cigarette smoking, high carbohydrate diet (>60% of energy intake) which are frequently encountered in routine clinical practice [2].
Hypertriglyceridemia, Lipoprotein lipase, Diabetes mellitus
Mukti NS, Rajkumar T, Rajiv S, Sabin R, Santosh KS (2026) Severe Hypertriglyceridemia Managed Successfully in Primary care: A Pragmatic Clinical Observation. On J Clin & Med Case Rep 2(3): 1-5. DOI: 10.64258/3067-7130.2026.1020045.