Experts from the National Lipid Association (NLA) and the American Society for Preventive Cardiology (ASPC) are recommending a new framework for categorizing and managing chylomicronemia, a severe form of hypertriglyceridemia. This consensus, published in the Journal of Clinical Lipidology, involved contributions from Baylor College of Medicine’s Dr. Christie Ballantyne and Université de Montréal’s Dr. Daniel Gaudet, along with Dr. Seyedmohammad Saadatagah and Miriam Larouche, MSc.
Traditionally, individuals with chylomicronemia are diagnosed with either familial chylomicronemia syndrome (FCS) or multifactorial chylomicronemia (MCS). FCS, affecting 1 to 10 people per million, results from biallelic pathogenic variants, whereas MCS, impacting 1 in 500 people, is caused by various genetic and environmental factors.
Dr. Ballantyne noted, “The current approach for chylomicronemia is focused on genotype, FCS or MCS, and there are no effective treatments for patients with severe forms other than lifestyle changes and triglyceride-lowering medications with limited efficacy." He emphasized the need for a new approach due to the complexity and lack of understanding among most physicians and patients.
The new pragmatic framework focuses on the severity of triglyceride elevations and the risk of complications, showing that over 90% of chylomicronemia patients can achieve partial control through lifestyle modification and medications. The term “persistent chylomicronemia” has been introduced to define cases where triglyceride levels exceed 1000 mg/dL in more than half of the measurements, indicating high pancreatitis risk.
Persistent chylomicronemia affects about 1 in 5500 individuals, a higher occurrence than FCS. Acute pancreatitis occurs in 26% of persistent chylomicronemia cases, with chronic pancreatitis in 12%. Alarm features within the persistent chylomicronemia group help identify high-risk patients for more targeted interventions.
Dr. Ballantyne stated, “This is a step toward more pragmatic and personalized approach in the management of chylomicronemia. By including this type of criteria and highlighting high-risk features, we can focus our intervention approaches and prevent severe outcomes like pancreatitis.”
While the consensus provides a promising framework, the researchers underlined the importance of further study in diverse populations to enhance criteria and treatment implications. Other contributors to the paper include Drs. Seyedmohammad Saadatagah, Miriam Larouche, Mohammadreza Naderian, Vijay Nambi, Diane Brisson, Iftikhar J. Kullo, Barton Duell, Erin D. Michos, Michael D. Shapiro, Gerald F. Watts, Daniel Gaudet, and Christie M. Ballantyne.
For detailed affiliations, disclosures, and funding, refer to the full publication.
