Hypertriglyceridemia

Last reviewed: 26 Aug 2023

Last updated: 06 Jun 2023

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.

Definition

HTG is defined as elevated fasting plasma triglyceride (TG), typically >75th or >95th percentile for age and sex.[1] 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).[2] Other lipoprotein abnormalities are often also present.[3] 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.[3][4]

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

ACUTE

chylomicronemia

ONGOING

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])

Contributors

Authors

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

London

Ontario

Canada

Disclosures

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.

Acknowledgements

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

Disclosures

DAL declares that he has no competing interests.

Peer reviewers

Vinaya Simha, MBBS, MD

Associate Professor

Mayo Clinic

Rochester

Disclosures

VS declares that he has no competing interests.

Differentials
- Diabetes
- Lipodystrophies
- Liver disease
More Differentials
Guidelines
- Cardiovascular disease: risk assessment and reduction, including lipid modification
- 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk
More Guidelines
Patient leaflets
High cholesterol
More Patient leaflets
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Hypertriglyceridemia

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

chylomicronemia

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])

Contributors

Authors

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

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Vinaya Simha, MBBS, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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