CLS CLS Triglyceride Disorders & Management 1 — Questions and Answers
Question 1: Which triglyceride level (mg/dL) is classified as 'very high' according to the National Cholesterol Education Program (NCEP) ATP III guidelines?
- ≥500 (Correct answer)
- ≥200
- ≥400
- ≥300
Correct answer: ≥500
NCEP ATP III classifies triglycerides ≥500 mg/dL as very high, which significantly increases pancreatitis risk.
Question 2: What is the primary mechanism by which fibrates reduce triglyceride levels?
- Activation of PPAR-α, increasing lipoprotein lipase activity (Correct answer)
- Inhibiting HMG-CoA reductase
- Blocking intestinal cholesterol absorption
- Increasing bile acid excretion
Correct answer: Activation of PPAR-α, increasing lipoprotein lipase activity
Fibrates activate PPAR-α, which upregulates lipoprotein lipase activity, enhancing VLDL and triglyceride catabolism.
Question 3: A patient with triglycerides of 850 mg/dL is at immediate risk for which serious complication?
- Acute pancreatitis (Correct answer)
- Ischemic stroke
- Deep vein thrombosis
- Peripheral artery disease
Correct answer: Acute pancreatitis
Severely elevated triglycerides (>500–1000 mg/dL) markedly increase the risk of acute pancreatitis due to chylomicron accumulation.
Question 4: Which lipoprotein is the primary carrier of endogenous triglycerides in the fasting state?
- VLDL (Correct answer)
- Chylomicrons
- IDL
- HDL
Correct answer: VLDL
VLDL (very low-density lipoprotein) is the primary transporter of endogenous triglycerides produced by the liver in the fasting state.
Question 5: Which omega-3 fatty acid formulation is FDA-approved at prescription doses specifically for severe hypertriglyceridemia (≥500 mg/dL)?
- Icosapentaenoic acid (EPA) ethyl esters (Vascepa) and omega-3-acid ethyl esters (Lovaza) (Correct answer)
- Fish oil supplements only
- Docosahexaenoic acid (DHA) only
- Alpha-linolenic acid (ALA)
Correct answer: Icosapentaenoic acid (EPA) ethyl esters (Vascepa) and omega-3-acid ethyl esters (Lovaza)
Both Vascepa (pure EPA) and Lovaza (EPA+DHA) are FDA-approved prescription omega-3 formulations for triglycerides ≥500 mg/dL.
Question 6: Lipoprotein lipase (LPL) deficiency most commonly presents with which triglyceride phenotype?
- Type I hyperlipoproteinemia with massive chylomicronemia (Correct answer)
- Type IIa with isolated LDL elevation
- Type III with IDL accumulation
- Type IV with mild VLDL elevation
Correct answer: Type I hyperlipoproteinemia with massive chylomicronemia
LPL deficiency causes type I hyperlipoproteinemia, characterized by massive chylomicronemia and triglycerides often exceeding 1,000 mg/dL.
CLS CLS Triglyceride Disorders & Management 1
Which triglyceride level (mg/dL) is classified as 'very high' according to the National Cholesterol Education Program (NCEP) ATP III guidelines?