What causes severely elevated triglycerides (hypertriglyceridemia)?

From the Guidelines

Severely elevated triglycerides, or hypertriglyceridemia, are primarily caused by a combination of factors including weight gain, lack of exercise, and a diet rich in simple carbohydrates, as well as secondary causes such as diabetes, obesity, and liver dysfunction, as noted in the most recent guidelines 1. The management of hypertriglyceridemia involves a multifaceted approach that includes lifestyle modifications and, when necessary, medication. Key lifestyle changes include:

• Reducing intake of simple carbohydrates, sugars, and saturated fats
• Increasing consumption of omega-3 fatty acids from fish or supplements
• Weight loss, even as little as 5-10%, which can significantly reduce triglyceride levels For patients with severe hypertriglyceridemia, defined as triglyceride levels ≥500 mg/dL, the risk of pancreatitis is significantly increased, and thus, immediate attention is required to prevent serious health complications 1. In terms of medication, fibrates like fenofibrate or gemfibrozil are typically first-line treatments for severe hypertriglyceridemia, with prescription-strength omega-3 fatty acids also being effective 1. Statins may be added if LDL cholesterol is also elevated, but they should not be used alone in patients with severe or very severe hypertriglyceridemia. The urgency in treating high triglycerides stems from their role in promoting inflammation and atherosclerosis, while levels above 1000 mg/dL significantly increase the risk of acute pancreatitis 1. Regular monitoring through lipid panels every 4-12 weeks is essential until levels normalize to below 150 mg/dL. It's also important to evaluate for secondary causes of hypertriglyceridemia and consider medical therapy to reduce the risk of pancreatitis in individuals with fasting triglyceride levels ≥500 mg/dL, as recommended in the latest standards of care 1.

From the FDA Drug Label

Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy. Diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus should be looked for and adequately treated. Estrogen therapy, thiazide diuretics and beta-blockers, are sometimes associated with massive rises in plasma triglycerides, especially in subjects with familial hypertriglyceridemia

The causes of severely elevated triglycerides (hypertriglyceridemia) include:

• Excess body weight
• Excess alcoholic intake
• Diseases contributory to hyperlipidemia, such as:
  • Hypothyroidism
  • Diabetes mellitus
• Certain medications, such as:
  • Estrogen therapy
  • Thiazide diuretics
  • Beta-blockers 2

From the Research

Causes of Severely Elevated Triglycerides

Severely elevated triglycerides, also known as hypertriglyceridemia, can be caused by a variety of factors, including:

• Obesity, metabolic syndrome, and type 2 diabetes mellitus 3
• Excessive alcohol use, physical inactivity, and being overweight 3
• Use of certain medications and genetic disorders 3
• High carbohydrate intake, especially refined carbohydrates, and low fat and protein intake 3

Risk Factors for Hypertriglyceridemia

The risk factors for hypertriglyceridemia include:

• Obesity and metabolic syndrome 3, 4
• Type 2 diabetes mellitus 3, 4
• Excessive alcohol use and physical inactivity 3
• Family history of hypertriglyceridemia and genetic disorders 3
• Certain medications, such as corticosteroids and beta-blockers 3

Consequences of Hypertriglyceridemia

Hypertriglyceridemia can lead to serious health consequences, including:

• Increased risk of cardiovascular disease 3, 5, 4
• Increased risk of acute pancreatitis, especially at very high levels of triglycerides 3, 6, 5, 7
• Increased risk of morbidity and mortality 6, 7

Management of Hypertriglyceridemia

The management of hypertriglyceridemia typically involves:

• Dietary changes, such as reducing carbohydrate intake and increasing fat and protein intake 3
• Increased physical activity, such as moderate- to high-intensity exercise 3
• Medications, such as statins, fibrates, niacin, and omega-3 fatty acids 3, 5, 4, 7
• Plasmapheresis and insulin infusion in cases of acute pancreatitis associated with hypertriglyceridemia 3, 6, 7