Hypertriglyceridemia (HTG) can be classified either according to the severity of triglyceride (TG) elevation or whether it is primary or secondary.
Primary HTG is rarely monogenic and typically polygenic in nature; secondary causes of HTG include lifestyle factors, medical conditions, and medications.
Mild-to-moderate HTG is associated with increased risk of atherosclerotic cardiovascular disease while severe HTG may cause acute pancreatitis.
Treatment begins with lifestyle modification and control of secondary factors.
Additional therapies include statins, fibrates, and prescription omega-3 acids.
HTG is defined as elevated fasting plasma triglyceride (TG), typically >75th or >95th percentile for age and sex. In the US, the American Heart Association/American College of Cardiology guidelines define moderate HTG as fasting or nonfasting TG 175-499 mg/dL (2.0 to 5.6 mmol/L) and severe HTG as fasting TG ≥500 mg/dL (≥5.6 mmol/L). Other lipoprotein abnormalities are often also present. Patients with HTG have an increased risk of atherosclerotic cardiovascular disease, and a severely elevated TG level (>885 mg/dL [>10 mmol/L]) is associated with an increased risk of acute pancreatitis.
History and exam
Key diagnostic factors
- eruptive xanthomas
- lipemia retinalis
Other diagnostic factors
- coronary artery disease/angina
- aortic valve disease
- neurologic features
- abdominal pain and features of pancreatitis
- 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
- Cushing syndrome
- inflammatory/immune disorders
- organ transplant
1st investigations to order
- triglyceride level
Investigations to consider
- apolipoprotein B
- fasting plasma glucose
- BUN, creatinine
- urinary albumin/protein
- serum albumin
- thyroid-stimulating hormone
- liver function tests
- C-reactive protein
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])
- Liver disease
- 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia
- 2021 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in adults
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