Last reviewed: 26 Aug 2023
Last updated: 06 Jun 2023



History and exam

Key diagnostic factors

  • eruptive xanthomas
  • lipemia retinalis
More key diagnostic factors

Other diagnostic factors

  • obesity/overweight
  • diabetes
  • lipodystrophy
  • coronary artery disease/angina
  • claudication
  • aortic valve disease
  • neurologic features
  • abdominal pain and features of pancreatitis
Other diagnostic factors

Risk factors

  • family history of hyperlipidemia
  • high saturated fat diet
  • high carbohydrate or high glycemic index diet
  • excessive alcohol consumption
  • family or personal history of overweight/obesity
  • family or personal history of diabetes
  • insulin resistance
  • liver disease
  • renal disease
  • HIV infection
  • medications
  • Cushing syndrome
  • inflammatory/immune disorders
  • organ transplant
  • hypothyroidism
  • pregnancy
More risk factors

Diagnostic investigations

1st investigations to order

  • triglyceride level
More 1st investigations to order

Investigations to consider

  • apolipoprotein B
  • fasting plasma glucose
  • BUN, creatinine
  • urinary albumin/protein
  • serum albumin
  • thyroid-stimulating hormone
  • liver function tests
  • C-reactive protein
More investigations to consider

Treatment algorithm




moderate HTG (fasting TG ≥150 mg/dL [≥1.7 mmol/L] or nonfasting TG ≥175 mg/dL [≥2.0 mmol/L] and TG <500 mg/dL [<5.6 mmol/L])

severe HTG (fasting TG ≥500 mg/dL [≥5.6 mmol/L] especially fasting TG ≥1000 mg/dL [≥11.3 mmol/L])



Robert A. Hegele, MD, FRCPC, Cert Endo, FACP, FAHA

Jacob J. Wolfe Distinguished Medical Research Chair

Martha Blackburn Chair in Cardiovascular Research

Distinguished University Professor of Medicine and Biochemistry

University of Western Ontario





RAH reports consulting fees from Acasti, Aegerion, Akcea/Ionis, Amgen, Boston Heart, HLS Therapeutics, Novartis, Pfizer, Regeneron, Sanofi and UltraGenyx. RAH is an author of references cited in this topic.


Dr Robert A. Hegele would like to gratefully acknowledge Dr David Alexander Leaf, the previous contributor to this topic.


DAL declares that he has no competing interests.

Peer reviewers

Vinaya Simha, MBBS, MD

Associate Professor

Mayo Clinic




VS declares that he has no competing interests.

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