Management of Severe Hypertriglyceridemia

Immediate Management

• The American College of Cardiology recommends implementing extreme dietary fat restriction (<5% of total calories as fat) until triglyceride levels decrease to ≤1000 mg/dL, and eliminating all added sugars from the diet 1, 2
• The American College of Cardiology suggests eliminating all alcohol consumption completely as it can precipitate hypertriglyceridemic pancreatitis 3
• The American College of Cardiology recommends screening for and treating secondary causes of hypertriglyceridemia, including uncontrolled diabetes, and alcohol use 1, 3, 4
• The American Academy of Family Physicians notes that pregnancy is a secondary cause of hypertriglyceridemia 5

Pharmacological Treatment

• The American Academy of Family Physicians recommends starting fibrate therapy immediately (first-line treatment for triglycerides ≥1500 mg/dL) 5, 6
• The American College of Cardiology suggests considering adding prescription omega-3 fatty acids if response to fibrate is inadequate 4
• The American College of Cardiology recommends avoiding statins as monotherapy for severe hypertriglyceridemia (≥1500 mg/dL), as they are not effective as first-line treatment for this condition 6

Long-term Management

• The American College of Cardiology recommends maintaining dietary fat restriction (10-15% of total calories) once triglycerides are <1000 mg/dL 2
• The American Heart Association suggests implementing a weight loss program if overweight/obese (5-10% weight reduction can lower triglycerides by approximately 20%) 7
• The American College of Cardiology recommends increasing physical activity (at least 150 minutes per week of moderate-intensity aerobic activity) 3