From the Guidelines
Elevated triglycerides are associated with increased risk of acute pancreatitis, cardiovascular disease, metabolic syndrome, and fatty liver disease, and management is crucial to reduce morbidity and mortality. The implications of hypertriglyceridemia are significant, and it is essential to address this condition to improve quality of life and reduce the risk of complications. According to the most recent and highest quality study 1, patients with severe hypertriglyceridemia (triglycerides ≥500 mg/dL and especially ≥1,000 mg/dL) are at increased risk of acute pancreatitis and cardiovascular disease. Some key points to consider in managing hypertriglyceridemia include:
- Lifestyle modifications, such as reducing intake of refined carbohydrates, sugary foods, and alcohol, and increasing physical activity to at least 150 minutes of moderate exercise weekly 2
- Consuming a Mediterranean-style diet rich in omega-3 fatty acids from fatty fish like salmon and sardines, and including fiber-rich foods such as vegetables, fruits, and whole grains 3
- Weight loss of 5-10% can significantly reduce triglyceride levels 4
- Medications, such as fibrates (fenofibrate 145 mg daily), prescription omega-3 fatty acids (icosapent ethyl 2 grams twice daily or omega-3 ethyl esters 2-4 grams daily), and statins if LDL cholesterol is also elevated, may be necessary if triglycerides remain above 500 mg/dL despite lifestyle changes 5 It is crucial to note that very high triglycerides (>1000 mg/dL) require immediate medical attention as they can cause pancreatitis. Overall, managing hypertriglyceridemia is essential to reduce the risk of complications and improve quality of life, and a comprehensive approach that includes lifestyle modifications and medications when necessary is recommended.
From the FDA Drug Label
Epidemiologic investigations have established that cardiovascular morbidity and mortality vary directly with the level of total-C, LDL-C, and TG, and inversely with the level of HDL-C. The implications of hypertriglyceridemia (elevated triglycerides) include:
- Increased risk of cardiovascular morbidity and mortality
- Association with human atherosclerosis
- Increased levels of total-C, LDL-C, and TG are directly related to cardiovascular risk
- Decreased levels of HDL-C are associated with the development of atherosclerosis 6 Note: The exact mechanisms and risks associated with hypertriglyceridemia are complex and multifactorial, and may involve other factors beyond just lipid levels.
From the Research
Implications of Hypertriglyceridemia
- Hypertriglyceridemia is associated with an increased risk of cardiovascular disease and pancreatitis 7, 8, 9, 10, 11
- Elevated triglyceride levels can induce acute pancreatitis, especially when levels exceed 1000 mg/dL (11.4 mmol/L) 7, 8
- The individual risk of cardiovascular disease and pancreatitis must be estimated to decide on the treatment approach for hypertriglyceridemia 7
Risk Factors and Associations
- Hypertriglyceridemia is often associated with overweight, metabolic syndrome, and diabetes mellitus 7, 8, 10
- Other risk factors for hypertriglyceridemia include obesity, excessive alcohol use, physical inactivity, and genetic disorders 8, 10
- Hypertriglyceridemia affects a significant portion of the adult population, with estimates ranging from 15-20% 7 to 33% 9 of the population
Treatment and Management
- Lifestyle modifications, such as cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control, are the most effective ways to lower triglyceride levels 7, 8, 10, 11
- Pharmacotherapy, including fibrates, omega-3 fatty acids, and niacin, may be necessary for patients with severely elevated triglyceride levels or those who do not respond to lifestyle modifications 7, 8, 9, 10, 11
- Statins may be considered for patients with high triglyceride levels who have borderline or intermediate risk of atherosclerotic cardiovascular disease 8, 9, 10