Review Article
Drug Treatment of Hypertriglyceridemia in Children
Ana Paula Marte Chacra1, Anita LR Saldanha2, Ana Paula Pantoja Margeotto2, André LV Gasparoto3 and Tania Leme da Rocha Martinez2*
1Heart Institute, Faculty of Medicine, University of São Paulo, Brazil
2Nephrology Department, BP - A Beneficência Portuguesa de São Paulo, Brazil
3Intensive Care Unit, BP - A Beneficência Portuguesa de São Paulo, Brazil
Tania Leme da Rocha Martinez, Department of Nephrology, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Received Date:March 21, 2022; Published Date: April 06, 2022
Abstract
Treatment of severe hypertriglyceridemia aims to treat and prevent complications including acute pancreatitis, mesenteric ischemia, and recurrent abdominal pain. The risk of pancreatitis increases with serum triglyceride levels above 1000 mg/dL. The aim of treatment is the reduction of triglycerides to values less than 1000 mg/dL. The indication of hospitalization should be for patients with symptoms and triglycerides values above 1000 mg/dL. Laboratory evaluation should include lipid, metabolic profile, renal function, electrolytes, liver function, glycemic profile, thyroid hormone and urine type I. Patients with severe hypertriglyceridemia and abdominal pain or pancreatitis should be kept fasting and intravenous hydration. The average fasting time is 48 hours. Insulin activates lipoprotein lipase and thus the lipolytic pathway of plasma triglycerides, facilitating the removal of these particles from the circulation, reducing their serum values. The use of plasmapheresis in children with severe hypertriglyceridemia is rare. Being an invasive procedure, it requires specialized centers. The efficacy of plasmapheresis in rapidly reducing plasma triglycerides is 70%. There are no triglycerides -reducing drugs approved for use in children and adolescents. Even without approval for children and adolescents, some of these drugs are used in the presence of fasting serum triglycerides concentrations above 500 mg/dL. Omega-3-fatty acids (omega-3-FA) can be used as adjuvant therapy when the triglycerides concentration is exceeded at 500 mg/dL. Omega-3-FA reduce the hepatic secretion of VLDL cholesterol and increase the catabolism of chylomicron. A new medication for familial chylomicronemia syndrome has been recently approved for adults in many European and South American countries, volanesorsen, an antisense oligoprotein that inhibits apoprotein CIII, a co-activator of lipoprotein lipase. This brings a lot of hope that can in the future be proved safe for children aswell.
Keywords:Familial Chylomicronemia Syndrome; Hypertriglyceridemia; Lipoprotein Lipase; Omega-3-Fatty Acids; Severe Hypertriglyceridemia;Triglycerides
Abbreviations:FCS: Familial Chylomicronemia Syndrome; HTG: Hypertriglyceridemia; LPL: Lipoprotein Lipase; Omega-3-FA: Omega-3-Fatty Acids; SHTG: Severe Hypertriglyceridemia; TG: Triglycerides
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Ana Paula Marte Chacra, Anita LR Saldanha, Ana Paula Pantoja Margeotto, André LV Gasparoto, Tania Leme da Rocha Martinez. Drug Treatment of Hypertriglyceridemia in Children. On J Cardio Res & Rep. 6(4): 2022. OJCRR.MS.ID.000642.