Management of Borderline High Triglycerides

Classification and Risk Assessment

A triglyceride level of 186 mg/dL falls into the borderline high category, which is associated with increased cardiovascular disease risk, according to the American Heart Association 1, 3
Borderline high triglycerides have been established as an independent risk factor for coronary heart disease through meta-analyses of prospective studies, as reported by the American College of Cardiology 1, 2

The American College of Cardiology recommends restricting added sugars to <6% of total daily calories 3
The American College of Cardiology suggests limiting total fat to 30-35% of total daily calories 5, 6
The American College of Cardiology advises reducing refined carbohydrate intake and replacing with fiber-rich whole grains (6 servings/day) 5, 7
The American College of Cardiology recommends emphasizing vegetables, legumes, and lean proteins 5, 7
The American College of Cardiology suggests limiting alcohol consumption to no more than 2 drinks/day for men and 1 drink/day for women 5, 7
The American College of Cardiology advises restricting sugar-sweetened beverages 5, 7

The American College of Cardiology recommends targeting a 5-10% weight loss, which can reduce triglycerides by approximately 20% 3
The American College of Cardiology suggests that weight loss is the most effective lifestyle intervention for lowering triglycerides 3
The American College of Cardiology advises engaging in at least 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous aerobic activity 3

The American College of Cardiology recommends screening for and addressing potential secondary causes of hypertriglyceridemia, including uncontrolled diabetes mellitus, hypothyroidism, excessive alcohol consumption, certain medications, chronic kidney disease, and obesity and metabolic syndrome 1, 3, 7

The American Heart Association recommends evaluating for other components of metabolic syndrome, including abdominal obesity, low HDL cholesterol, elevated blood pressure, and elevated fasting glucose 1, 2, 8
The American Heart Association defines metabolic syndrome as the presence of 3 or more of these characteristics 1, 8

The American College of Cardiology suggests that pharmacologic therapy is generally not the first-line approach for borderline high triglycerides unless other cardiovascular risk factors are present 3
The American College of Cardiology recommends considering statins for patients with elevated LDL-C or increased cardiovascular risk, as they can provide a 10-30% reduction in triglycerides 3

The American College of Cardiology recommends reassessing fasting lipid panel in 6-12 weeks after implementing lifestyle modifications 3
The American Heart Association suggests monitoring for changes in other lipid parameters (LDL-C, HDL-C, non-HDL-C) 1, 2
The American College of Cardiology advises considering non-HDL cholesterol as a secondary target, with a goal of <130 mg/dL, if triglycerides increase to ≥200 mg/dL 1, 2, 8