What is the recommended triglyceride goal?

Recommended Triglyceride Goal

The recommended triglyceride goal is less than 150 mg/dL (1.7 mmol/L) for adults. 1

Understanding Triglyceride Levels

• Triglycerides are a marker for the concentration of triglycerides carried in chylomicrons and very low-density lipoprotein particles 2
• A fasting triglyceride level <150 mg/dL is widely accepted as the upper limit of normal range 2, 1
• 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 3

Classification of Triglyceride Levels

• Normal: <150 mg/dL (1.7 mmol/L) 1
• Mild hypertriglyceridemia: 150-199 mg/dL 2
• Moderate hypertriglyceridemia: 200-499 mg/dL 2
• Moderate to severe hypertriglyceridemia: 500-999 mg/dL 2
• Severe hypertriglyceridemia: ≥1000 mg/dL 2

Clinical Implications of Elevated Triglycerides

• Triglyceride levels between 150-499 mg/dL increase the risk of atherosclerotic cardiovascular disease 4
• Severely elevated triglyceride levels (≥500 mg/dL) significantly increase the risk of pancreatitis 4
• Non-HDL cholesterol goal attainment declines at higher triglyceride concentrations, indicating a continuous inverse relationship 5

Management Approach Based on Triglyceride Levels

For Triglycerides <150 mg/dL (Target Level)

• Continue routine monitoring 1
• 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 1, 6

For Triglycerides 150-499 mg/dL

• Primary focus should be on LDL-C reduction and non-HDL cholesterol goals 3
• Lifestyle modifications are first-line therapy 1, 4:
  • Weight loss (5-10% reduction in body weight can reduce TG by approximately 20%) 3
  • Reduced carbohydrate intake, especially refined carbohydrates 4
  • Increased omega-3 fatty acid consumption 4
  • Moderate to high-intensity physical activity 4
  • Reduced alcohol consumption 2
• Consider statin therapy based on cardiovascular risk assessment 4
• 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 3
• Consider fibrates, omega-3 fatty acids, or niacin in addition to lifestyle modifications 4
• 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
• 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 1

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 1
• 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 4

Monitoring Recommendations

• Lipid levels should be measured at least annually in adults with risk factors 1
• More frequent monitoring may be needed for patients on lipid-lowering therapy or with persistently elevated triglycerides 1