Management of Patients with Type V Hyperlipoproteinemia: An Uncommon Phenotype of Dyslipidemia with Chylomicronemia and Severe Hypertriglyceridemia

Q: What are the key findings of this study?

Patients with type V hyperlipoproteinemia had greater 6-month triglyceride reductions on statin and fenofibrate than type IV patients, but retained persistent HTG and increased LDL-C.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertriglyceridemia (Type V vs. Type IV hyperlipoproteinemia) (n=90). Intervention: Type V hyperlipoproteinemia (HLP5) phenotype treated with statin and fenofibrate vs. Type IV hyperlipoproteinemia (HLP4) phenotype on lipid-lowering therapy. Primary outcome: Fasting plasma triglyceride (TG) level and percentage change at 6 months (p=<0.01).

Q: What does this research mean for the field?

Despite greater relative triglyceride reductions with combined statin and fenofibrate therapy compared to type IV hyperlipoproteinemia, patients with type V hyperlipoproteinemia retain persistent severe hypertriglyceridemia and exhibit a paradoxical increase in LDL cholesterol. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate real-world clinical characteristics, treatment patterns, and 6-month lipid outcomes in patients with type V hyperlipoproteinemia compared with type IV hyperlipoproteinemia.

Ya-Hui Chang; Dai-Yi Lin; Chia-Ling Tsai; Chih-Hung Liang; Yu‐Ting Yu; Yi‐Lin Hsieh; Jen-Yu Chuang; Yihan Chen; Hung‐I Yeh; Chao‐Feng Lin

doi:10.3390/jpm13010068

December 28, 2022Journal of Personalized MedicineOpen Access

Management of Patients with Type V Hyperlipoproteinemia: An Uncommon Phenotype of Dyslipidemia with Chylomicronemia and Severe Hypertriglyceridemia

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Key result

Statin-fenofibrate therapy cuts triglycerides ~66% in type V hyperlipoproteinemia but leaves persistent hypertriglyceridemia.

P<0.01
n=90

Figures

Why the study?

Hypertriglyceridemia is a risk-enhancing factor for atherosclerotic cardiovascular disease, but real-world data on managing type V hyperlipoproteinemia were needed.

How do lipid profile responses and persistent hypertriglyceridemia compare at 6 months between patients with type V hyperlipoproteinemia and those with type IV hyperlipoproteinemia receiving real-world lipid-lowering therapy?

Key Points

To evaluate real-world clinical characteristics, treatment patterns, and 6-month lipid outcomes in patients with type V hyperlipoproteinemia compared with type IV hyperlipoproteinemia.
Observational study evaluating 90 patients with hypertriglyceridemia identified by plasma apolipoprotein B algorithms and lipoprotein electrophoresis between July 2018 and May 2021.
Compared baseline profiles and 6-month responses to lipid-lowering therapy between 7 patients with type V hyperlipoproteinemia and 83 patients with type IV hyperlipoproteinemia.
At baseline, patients with type V hyperlipoproteinemia had higher total cholesterol (264.9 ± 26.7 mg/dL vs. 183.9 ± 26.1 mg/dL; p < 0.01) and triglycerides (1296.7 ± 380.5 mg/dL vs. 247.6 ± 96.1 mg/dL; p < 0.01), but lower LDL-C (62.9 ± 16.4 mg/dL vs. 103.0 ± 21.1 mg/dL; p < 0.01).
All patients with type V hyperlipoproteinemia received combined statin and fenofibrate therapy, achieving a greater percentage reduction in triglycerides (-65.9 ± 13.7% vs. -27.9 ± 30.5%; p < 0.01) than type IV patients.
Despite greater relative reductions, type V patients maintained persistent hypertriglyceridemia (440.1 ± 239.0 mg/dL vs. 173.9 ± 94.8 mg/dL; p < 0.01) and experienced an increase in LDL-C (28.3 ± 57.2% vs. -19.5 ± 32.0%; p < 0.01) after 6 months.

Study Design

Type

Cohort (n=90)

Multicenter

No

Structured PICO

How do lipid profile responses and persistent hypertriglyceridemia compare at 6 months between patients with type V hyperlipoproteinemia and those with type IV hyperlipoproteinemia receiving real-world lipid-lowering therapy?

P

Population

90 adults (>=20 years) in Taiwan with fasting hypertriglyceridemia (>=150 mg/dL) classified as type V (n=7, mean age 41.6) or type IV (n=83, mean age 57.4) hyperlipoproteinemia, followed for 6 months on lipid-lowering therapy.

E

Exposure

Type V hyperlipoproteinemia (HLP5) phenotype managed with aggressive lipid-lowering therapy (100% received statin in combination with fenofibrate by 6 months) for 6 months

C

Comparator

Type IV hyperlipoproteinemia (HLP4) phenotype managed with clinical lipid-lowering therapy (including statins, high-intensity statins, ezetimibe, and fenofibrate in 26.5%) for 6 months

O

Outcome

Fasting plasma lipid parameters (TC, TG, LDL-C, HDL-C, non-HDL-C, apoB), percentage change in each lipid parameter, and prescription rates of lipid-lowering therapy at 6-month follow-upsurrogate

Main Result

Absolute Event Rate: -65.9% vs -27.9%

p-value: p=<0.01

Even with aggressive combination statin and fenofibrate therapy, patients with type V hyperlipoproteinemia experience persistent hypertriglyceridemia, a paradoxical rise in LDL-C, and minimal apoB reduction, underscoring an unmet need for novel triglyceride-lowering therapies and dedicated clinical guidelines.

Limitations

Relatively small patient population due to single-center design and uncommon prevalence of HLP5
ApoB diagnostic algorithm was not previously validated in Taiwanese cohorts
Potential changes in diet and body weight during the study period were not surveyed, and lipoprotein electrophoresis was not routinely repeated after treatment
Use of omega-3 fatty acids was very limited due to lack of reimbursement by Taiwan's national health insurance
Clinical cardiovascular outcomes, preclinical atherosclerosis, and proinflammatory cytokines were not measured
Small sample size and single-center study design with only 7 HLP5 patients
ApoB algorithm was not previously validated in Taiwanese cohorts
Dietary changes and body weight changes during follow-up were not surveyed, and follow-up lipoprotein electrophoresis was not routinely performed
Very limited use of omega-3 fatty acids due to lack of national health insurance reimbursement
No assessment of clinical cardiovascular outcomes, preclinical atherosclerosis, or proinflammatory cytokines

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Persistent hypertriglyceridemia despite combination therapy supports caution in type V management; leaves open need for targeted agents in this phenotype.

Abstract

Hypertriglyceridemia (HTG) remains a risk-enhancing factor of atherosclerotic cardiovascular disease. We aimed to report real-world data on the management of patients with type V hyperlipoproteinemia (HLP5), an uncommon phenotype of dyslipidemia characterized by fasting chylomicronemia and severe HTG. Between July 2018 and May 2021, 90 patients with HTG, including 83 patients with type IV hyperlipoproteinemia (HLP4) and 7 patients with HLP5, were identified by plasma apolipoprotein B (apoB) and lipoprotein electrophoresis. Patients with HLP5 were younger, had higher total cholesterol (TC) (264.9 ± 26.7 mg/dL vs. 183.9 ± 26.1 mg/dL; p < 0.01) and higher triglyceride (TG) (1296.7 ± 380.5 mg/dL vs. 247.6 ± 96.1 mg/dL; p < 0.01), and had lower high-density lipoprotein cholesterol (HDL-C) (30.6 ± 4.8 mg/dL vs. 40.5 ± 8.7 mg/dL; p < 0.01) and lower low-density lipoprotein cholesterol (LDL-C) (62.9 ± 16.4 vs. 103.0 ± 21.1 mg/dL; p < 0.01) compared with patients with HLP4. Despite an aggressive use of statin and fenofibrate with greater reductions in TG (-65.9 ± 13.7% vs. -27.9 ± 30.5%; p < 0.01) following 6 months of treatment, patients with HLP5 had persistent HTG (440.1 ± 239.0 mg/dL vs. 173.9 ± 94.8 mg/dL; p < 0.01) and an increase in LDL-C (28.3 ± 57.2% vs. -19.5 ± 32.0%; p < 0.01) compared with patients with HLP4. Our findings highlight that the lack of novel TG-lowering medications and management guidelines remains an unmet medical need in patients with HLP5. Closely monitoring lipid profiles, full assessment of individual’s risk of cardiovascular disease, and emphasis on medication adherence are of clinical importance.

Discussion

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Cite This Study

Chang et al. (2022) conducted a cohort in Hypertriglyceridemia (Type V vs. Type IV hyperlipoproteinemia) (n=90). Type V hyperlipoproteinemia (HLP5) phenotype treated with statin and fenofibrate vs. Type IV hyperlipoproteinemia (HLP4) phenotype on lipid-lowering therapy was evaluated on Fasting plasma triglyceride (TG) level and percentage change at 6 months (p=<0.01). Patients with type V hyperlipoproteinemia had greater 6-month triglyceride reductions on statin and fenofibrate than type IV patients, but retained persistent HTG and increased LDL-C.

synapsesocial.com/papers/6a75a5751375d8fff1e8c736 https://doi.org/10.3390/jpm13010068

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Management of Patients with Type V Hyperlipoproteinemia: An Uncommon Phenotype of Dyslipidemia with Chylomicronemia and Severe Hypertriglyceridemia

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Management of Patients with Type V Hyperlipoproteinemia: An Uncommon Phenotype of Dyslipidemia with Chylomicronemia and Severe Hypertriglyceridemia

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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