How are elevated triglyceride levels managed?

What Increases Triglyceride Levels in the Blood

Multiple dietary, lifestyle, and medical factors can significantly elevate triglyceride levels, with alcohol consumption, excess body weight, refined carbohydrates, and certain medications being the most common culprits.

Primary Dietary and Lifestyle Factors

Alcohol Consumption

• Alcohol consumption of just 1 ounce per day corresponds to a 5-10% higher triglyceride concentration compared to non-drinkers 1
• The effects of alcohol are synergistically exaggerated when coupled with meals high in saturated fat, as alcohol impairs chylomicron hydrolysis and increases triglyceride-rich VLDL production 1
• Excess alcohol consumption, particularly in individuals with pre-existing hypertriglyceridemia, can precipitate marked triglyceride elevation often ≥250 mg/dL and trigger hypertriglyceridemic pancreatitis 1
• Patients with severe hypertriglyceridemia should not consume alcohol under any circumstances 1

Dietary Carbohydrates and Sugars

• Added sugars and refined carbohydrates directly increase hepatic triglyceride production 2
• Replacing saturated fat with refined carbohydrates increases triglycerides by approximately 1.9 mg/dL per 1% energy substitution 2
• Sugar-sweetened beverages are a significant contributor to elevated triglyceride levels 3

Excess Body Weight and Obesity

• Excess body weight and visceral adiposity are important factors in hypertriglyceridemia, associated with reduced oxidation of muscle fatty acids 1
• Obesity and metabolic syndrome are primary contributors that should be addressed before initiating drug therapy 4
• Central obesity is a key component of metabolic syndrome that drives triglyceride elevation 5, 6

Physical Inactivity

• A sedentary lifestyle is strongly associated with elevated triglyceride levels 1
• Physical inactivity reduces fatty acid oxidative capacity in skeletal muscle 7

Medical Conditions That Increase Triglycerides

Endocrine and Metabolic Disorders

• Uncontrolled diabetes mellitus is often the primary driver of severe hypertriglyceridemia, as poor glycemic control dramatically increases triglyceride production 1, 2
• Hypothyroidism contributes to elevated triglyceride levels and should be screened for and adequately treated 4, 5
• Metabolic syndrome, characterized by insulin resistance, is a major cause of hypertriglyceridemia 6

Renal and Hepatic Disease

• Chronic kidney disease and nephrotic syndrome elevate triglyceride levels 1
• Chronic liver disease contributes to disordered triglyceride metabolism 1

Medications That Raise Triglycerides

Hormone Therapies

• Estrogen therapy can greatly influence triglyceride levels, particularly oral contraceptive preparations in women of reproductive age 1
• Oral postmenopausal hormone preparations increase triglycerides more than transdermal preparations 1

Cardiovascular Medications

• Thiazide diuretics are associated with massive rises in plasma triglycerides, especially in subjects with familial hypertriglyceridemia 4
• Beta-blockers can significantly elevate triglyceride levels 4

Other Medications

• Corticosteroids increase triglyceride production 2
• Antiretroviral medications used in HIV treatment elevate triglycerides 1
• Antipsychotic medications contribute to hypertriglyceridemia 2

Genetic and Primary Causes

• Primary hypertriglyceridemia results from various genetic defects leading to disordered triglyceride metabolism 6
• Familial hypertriglyceridemia makes patients particularly susceptible to medication-induced triglyceride elevation 4

Clinical Implications

When evaluating elevated triglycerides, clinicians must systematically assess for these secondary causes before attributing the elevation to primary genetic disorders. The FDA label for fenofibrate explicitly states that excess body weight and excess alcoholic intake should be addressed prior to any drug therapy, and that diseases contributory to hyperlipidemia should be looked for and adequately treated 4. Discontinuation of specific etiologic agents (such as estrogen therapy, thiazide diuretics, or beta-blockers) may obviate the need for specific drug therapy of hypertriglyceridemia 4.