Core IM | Internal Medicine Podcast #194: Severe Hypertriglyceridemia: 5 Pearls Segment
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Dec 3, 2025 Dr. Greg Katz, a cardiologist from NYU, and Dr. Seth Baum, a preventive cardiologist, delve into the hazards of severe hypertriglyceridemia. They discuss how quickly triglyceride levels can rise and the associated risks of pancreatitis. The duo emphasizes the importance of lifestyle changes, such as diet and exercise, in managing triglyceride levels. Medications like statins and prescription omega-3s are highlighted for reducing high levels. They also touch on genetic factors and the urgency of treatment when triglycerides exceed 500 mg/dL.
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Rapid TG Rise After Fatty Meals
- Lipoprotein lipase saturates around triglycerides of 500–600 mg/dL, so levels near 400–600 can spike rapidly after a fatty meal.
- That acute rise greatly increases pancreatitis risk as chylomicrons accumulate.
TG Thresholds And Pancreatitis Risk
- Triglyceride levels >500 mg/dL markedly raise acute pancreatitis risk and severity.
- Prior pancreatitis lowers the threshold for recurrence at even lower triglyceride levels.
Rule Out Secondary Causes First
- Screen and treat secondary causes before assuming primary lipid disease: check thyroid, nephrotic proteinuria, and cortisol exposure.
- Review medications like glucocorticoids and atypical antipsychotics as reversible contributors.