Incidence increasing along with number of patients who are overweight or obese.
Associated with increased cardiovascular risk.
May cause acute pancreatitis when fasting levels >5.7 mmol/L (500 mg/dL).
Treatment includes lifestyle modification for all patients.
Statins are generally first-line pharmacotherapy in patients with triglycerides <5.69 mmol/L (<500 mg/dL) in the presence of ≥2 cardiac risk factors.
Fibric acid derivatives or fish oils are used as first-line therapy in those with triglycerides ≥5.69 mmol/L (≥500 mg/dL). They may be added to statins to achieve targets in patients with triglycerides <5.69 mmol/L (<500 mg/dL).
Hypertriglyceridaemia is defined by the National Cholesterol Education Program Adult Treatment Panel III as fasting plasma triglyceride level ≥2.3 mmol/L (≥200 mg/dL). Borderline high is defined as 150 to 199 mg/dL, high as 200 to 499 mg/dL, and very high as ≥500 mg/dL. Chylomicronaemia is present when triglyceride level is ≥11.3 mmol/L (≥1000 mg/dL). Guidelines from several national and international medical organisations regarding the determination and treatment of hypertriglyceridaemia use different nomenclature, yet are similar in their recommendations.
History and exam
Key diagnostic factors
- presence of risk factors
- lipaemia retinalis
- eruptive xanthoma
Other diagnostic factors
- coronary artery disease
- abdominal pain and other features of pancreatitis
- family history of hyperlipidaemia
- family history of diabetes
- overweight/obese patients
- high-saturated-fat diet
- high-carbohydrate diet
- insulin resistance
- liver disease
- renal disease
- excessive alcohol consumption
- HIV infection
- cystic fibrosis
- Cushing's syndrome
- acute spinal cord injury
- inflammatory/immune disorders
- anorexia nervosa
- organ transplant
1st investigations to order
- fasting triglycerides
Investigations to consider
- thyroid-stimulating hormone
- fasting plasma glucose
- urea, creatinine
- serum albumin
- liver function tests
- serum protein electrophoresis
- computed tomography abdomen
with clinical atherosclerotic cardiovascular disease ≤75 years
with clinical atherosclerotic cardiovascular disease >75 years
without clinical atherosclerotic cardiovascular disease: low-density lipoprotein cholesterol ≥4.92 mmol/L (≥190 mg/dL)
without clinical atherosclerotic cardiovascular disease: 40-75 years without diabetes mellitus (low-density lipoprotein cholesterol 1.81-4.87 mmol/L [70-189 mg/dL])
without clinical atherosclerotic cardiovascular disease: 40-75 years with diabetes mellitus (low-density lipoprotein cholesterol 1.81-4.87 mmol/L [70-189 mg/dL])
triglycerides ≥5.7 mmol/L (≥500 mg/dL)
David Alexander Leaf, MD, MPH
Professor of Medicine
Playa Vista Medical Center
DAL is an author of several references cited in this monograph.
Mahi Lakshmi Ashwath, MD
Assistant Professor of Medicine
Division of Cardiology
Heart and Vascular Center
Metro Health Medical Center
Case Western Reserve University
MLA declares that he has no competing interests.
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