| Abstract [eng] |
Rationale: Hypertriglyceridemia is a significant lipid metabolism disorder associated with acute pancreatitis and atherosclerotic cardiovascular disease risk. In cases of very severe hypertriglyceridemia, etiological diagnosis, long-term control of triglyceride levels, and prevention of pancreatitis remain challenging, particularly when the response to standard lipid-lowering therapy is insufficient. Aim: To evaluate the diagnostic and therapeutic challenges of severe hypertriglyceridemia and the difficulties in preventing recurrent pancreatitis based on a clinical case, and to discuss the role of hypertriglyceridemia in atherosclerotic cardiovascular disease risk. Methods: A descriptive analysis of a single clinical case was performed based on the patient’s medical history, laboratory data, genetic testing results, and treatment data. The clinical course, changes in laboratory parameters, and treatment outcomes were presented chronologically. The clinical case data were presented while ensuring patient confidentiality and without disclosing any information that could enable identification of the patient. A literature review was also conducted on the metabolism of triglyceride-rich lipoproteins, severe hypertriglyceridemia, and its associations with acute pancreatitis and atherosclerotic cardiovascular disease. The literature search was performed in the PubMed, Google Scholar, Cochrane Library, and ScienceDirect databases, selecting relevant publications in English. Results: This study presents the clinical case of a 54-year-old man who has been diagnosed with very severe hypertriglyceridemia for more than three decades, recurrent episodes of acute pancreatitis, and an inadequate response to standard triglyceride-lowering therapy. Genetic testing was performed to investigate the etiology of hypertriglyceridemia, but no genetic cause of hypertriglyceridemia was identified. Nevertheless, in clinical differential diagnosis, familial chylomicronemia syndrome was considered alongside multifactorial chylomicronemia and other causes of hypertriglyceridemia. The patient was also diagnosed with atherosclerotic cardiovascular disease, type 2 diabetes, and obesity. Therefore, the treatment strategy must prioritize the prevention of both pancreatitis recurrence and cardiovascular risk. Conclusions: Hypertriglyceridemia plays a significant role in the development of both acute pancreatitis and atherosclerotic cardiovascular disease. The etiological diagnosis of severe hypertriglyceridemia remains challenging due to the interaction of genetic and secondary factors, and conventional treatment measures do not always ensure adequate control of triglyceride levels. Such patients require a comprehensive, individualized treatment plan that includes correction of secondary factors, prevention of pancreatitis recurrence, reduction of atherosclerotic risk, and the potential incorporation of new treatment modalities targeting the underlying mechanisms of the disease. |
