Recommended Triglyceride Goal
The recommended triglyceride goal is less than 150 mg/dL (1.7 mmol/L) for adults. 1, 2, 3
Understanding Triglyceride Levels
- Triglycerides are a marker for the concentration of triglycerides carried in chylomicrons and very low-density lipoprotein particles 4
- A fasting triglyceride level <150 mg/dL is widely accepted as the upper limit of normal range 4, 2
- Elevated triglycerides (≥150 mg/dL) put approximately 25% of the United States population at increased risk of cardiovascular disease, non-alcoholic fatty liver disease, and pancreatitis 5
Classification of Triglyceride Levels
- Normal: <150 mg/dL (1.7 mmol/L) 1, 2
- Mild hypertriglyceridemia: 150-199 mg/dL 4
- Moderate hypertriglyceridemia: 200-499 mg/dL 4
- Moderate to severe hypertriglyceridemia: 500-999 mg/dL 4
- Severe hypertriglyceridemia: ≥1000 mg/dL 4
Clinical Implications of Elevated Triglycerides
- Triglyceride levels between 150-499 mg/dL increase the risk of atherosclerotic cardiovascular disease 6
- Severely elevated triglyceride levels (≥500 mg/dL) significantly increase the risk of pancreatitis 6
- Non-HDL cholesterol goal attainment declines at higher triglyceride concentrations, indicating a continuous inverse relationship 7
Management Approach Based on Triglyceride Levels
For Triglycerides <150 mg/dL (Target Level)
- Continue routine monitoring 2
- In adults with low-risk lipid values (LDL-C <100 mg/dL, HDL-C >50 mg/dL, and triglycerides <150 mg/dL), lipid assessments may be repeated every 2 years 2, 8
For Triglycerides 150-499 mg/dL
- Primary focus should be on LDL-C reduction and non-HDL cholesterol goals 5
- Lifestyle modifications are first-line therapy 2, 6:
- Consider statin therapy based on cardiovascular risk assessment 6
- For patients with diabetes and elevated triglycerides, improved glycemic control can be very effective for reducing triglyceride levels 1
For Triglycerides ≥500 mg/dL
- Primary goal is to reduce triglyceride levels to lower the risk of pancreatitis 5
- Consider fibrates, omega-3 fatty acids, or niacin in addition to lifestyle modifications 6
- For patients with diabetes, insulin therapy (alone or with insulin sensitizers) may be particularly effective in lowering triglyceride levels 1
Special Considerations
For Patients with Diabetes
- The recommended triglyceride goal remains <150 mg/dL 1, 2
- In women with diabetes, who tend to have higher HDL cholesterol levels than men, an HDL goal 10 mg/dL higher (50 mg/dL) may be appropriate 1
- For children and adolescents with diabetes, optimal goals are triglycerides <150 mg/dL 3
For Patients with High Cardiovascular Risk
- When a high-risk patient has high triglycerides or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug 9, 10
- For patients at high risk who continue to have high triglyceride levels despite statin use, high-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality 6