Management of Hypertriglyceridemia
Classification and Risk Assessment
- The American College of Cardiology states that moderate hypertriglyceridemia is associated with increased cardiovascular disease risk, defined as triglyceride levels between 150-499 mg/dL 1
- Severe hypertriglyceridemia, defined as triglyceride levels between 500-999 mg/dL, is associated with an increased risk of pancreatitis and cardiovascular disease 1, 2
- Very severe hypertriglyceridemia, defined as triglyceride levels ≥1,000 mg/dL, is associated with a high risk for acute pancreatitis 1, 2, 3
First-Line Management for Severe Hypertriglyceridemia (≥500 mg/dL)
- The American College of Cardiology recommends restricting dietary fat to 20-25% of total calories for patients with triglyceride levels between 500-999 mg/dL 1
- For patients with triglyceride levels ≥1,000 mg/dL, a very low-fat diet (10-15% of total calories) is recommended 2, 3
- Eliminating added sugars completely and alcohol consumption is recommended for patients with triglyceride levels ≥1,000 mg/dL 2, 3
- Fibrates, such as fenofibrate, are first-line therapy for severe hypertriglyceridemia to prevent acute pancreatitis 1, 2
Management of Very Severe Hypertriglyceridemia (≥1,000 mg/dL)
- Insulin therapy may be considered for acute management of very severe hypertriglyceridemia, especially in patients with poor glycemic control 4
- The American College of Cardiology recommends addressing glycemic control first, then re-evaluating triglyceride levels in patients with diabetes and severe hypertriglyceridemia 2, 3
- Prescription omega-3 fatty acids (icosapent ethyl or omega-3 acid ethyl esters) may be considered as adjunctive therapy for patients with very severe hypertriglyceridemia 2, 3
Addressing Secondary Causes
- The American College of Cardiology recommends identifying and treating secondary causes of hypertriglyceridemia, including poorly controlled diabetes mellitus, obesity and metabolic syndrome, hypothyroidism, and chronic kidney disease 1, 5