Extreme hypertriglyceridemia: frequency of occurrence, clinical aspects, and efficacy of different therapeutic approaches

Aim . To evaluate the prevalence, clinical features, and effectiveness of various lipid-lowering therapy (LLT) regimens in patients with extreme hypertriglyceridemia (EHTG). Material and methods . A retrospective analysis of a database comprising 170,640 patients from a cardiology inpatient unit and outpatient clinics was conducted (2018-2024) to identify cases of EHTG. The study included 155 patients with triglyceride (TG) levels exceeding 10 mmol/L. Twenty-three patients receiving cascade plasmafiltration were excluded from the analysis of pharmacological therapy effectivenesse. The final analysis of the efficacy of various LLT regimens was performed in 114 patients with maintained treatment adherence. Clinical characteristics, lipid profiles, over a follow-up period of at least 12 months were assessed. Results . The prevalence of EHTG was 0.1%. The median age of patients was 50 [43-59] years, with 62% being men. The frequency of risk factors was as follows: obesity (58%), arterial hypertension (64%), type 2 diabetes mellitus (44%), and smoking (41%). A history of acute pancreatitis was present in 41% of patients, and pancreatic necrosis in 18%. Coronary artery disease was diagnosed in 56% of patients, with its onset preceding hyperlipidemic therapy (HLT) in 92% of cases. Atherosclerosis of carotid and lower limb arteries was detected in 52% and 55% of patients, respectively. Initially, there was a significant elevation in triglyceride levels (13.1 [11.3-26.4] mmol/L), while high-density lipoprotein cholesterol levels were low (0.8 [0.6–0.9] mmol/L). LLT resulted in a threefold reduction of TG levels to 4.2 [2.9–6.0] mmol/L. The highest treatment effectiveness was observed with a combination of fibrates, statins, and omega-3 polyunsaturated fatty acids (PUFAs), resulting in a 79.3% reduction in triglycerides; this was followed by a combination of fibrates with omega-3 PUFAs (71.5%). The smallest triglyceride reduction was recorded with statin monotherapy (51.6%). An analysis of the various regimens effectiveness also highlighted the importance of dietary adherence and lifestyle modification for achieving optimal results. A significant reduction in TG levels was revealed with combination therapy compared to monotherapy or no treatment. Conclusion . EHTG is a rare condition (0.1%) but is associated with a high frequency of pancreatitis and atherosclerotic lesions. Combination therapy including fibrates, statins, and omega-3 PUFAs demonstrates the highest effectiveness in reducing TG levels.