Hypertriglyceridaemia

Last reviewed: 21 Apr 2022

Last updated: 03 Oct 2018

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).

Definition

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.[1][2] 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.[3][4][5]

History and exam

Key diagnostic factors

presence of risk factors
lipaemia retinalis
eruptive xanthoma

More key diagnostic factors

Other diagnostic factors

obesity/overweight
diabetes
coronary artery disease
angina/claudication
abdominal pain and other features of pancreatitis

Other diagnostic factors

Risk factors

family history of hyperlipidaemia
family history of diabetes
overweight/obese patients
high-saturated-fat diet
high-carbohydrate diet
insulin resistance
liver disease
hypothyroidism
renal disease
excessive alcohol consumption
HIV infection
cystic fibrosis
medications
Cushing's syndrome
acute spinal cord injury
inflammatory/immune disorders
anorexia nervosa
organ transplant

More risk factors

Diagnostic investigations

1st investigations to order

fasting triglycerides

More 1st investigations to order

Investigations to consider

thyroid-stimulating hormone
fasting plasma glucose
urea, creatinine
serum albumin
liver function tests
serum protein electrophoresis
computed tomography abdomen

More investigations to consider

Treatment algorithm

ACUTE

chylomicronaemia

ONGOING

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)

Contributors

Authors

David Alexander Leaf, MD, MPH

Professor of Medicine

Playa Vista Medical Center

Los Angeles

Disclosures

DAL is an author of several references cited in this monograph.

Peer reviewers

Mahi Lakshmi Ashwath, MD

Assistant Professor of Medicine

Division of Cardiology

Heart and Vascular Center

Metro Health Medical Center

Case Western Reserve University

Cleveland

Disclosures

MLA declares that he has no competing interests.

Differentials
- Diabetes
- Liver disease
- Hypothyroidism
More Differentials
Guidelines
- Familial hypercholesterolaemia: identification and management
- Risk estimation and the prevention of cardiovascular disease
More Guidelines
Patient leaflets
High cholesterol
More Patient leaflets
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Hypertriglyceridaemia

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

chylomicronaemia

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)

Contributors

Authors

David Alexander Leaf, MD, MPH

Disclosures

Peer reviewers

Mahi Lakshmi Ashwath, MD

Disclosures

Differentials

Guidelines

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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