What is the treatment for elevated triglycerides (hypertriglyceridemia)?

Treatment for Triglycerides 175 mg/dL

For a triglyceride level of 175 mg/dL, initiate aggressive lifestyle modifications as first-line therapy, including a 5-10% weight reduction target, restriction of added sugars to <6% of total daily calories, limitation of total fat to 30-35% of calories, complete alcohol avoidance or severe restriction, and at least 150 minutes weekly of moderate-intensity aerobic activity. 1

Classification and Risk Context

Your triglyceride level of 175 mg/dL falls into the mild hypertriglyceridemia category (150-199 mg/dL range), which is classified as a cardiovascular risk-enhancing factor but does not pose an immediate pancreatitis risk. 1, 2 This level warrants intervention primarily to reduce long-term cardiovascular disease risk rather than acute complications. 3

Mandatory Initial Assessment

Before any treatment decisions, evaluate for secondary causes that may be driving the elevation: 1, 2

• Excessive alcohol intake - even 1 ounce daily increases triglycerides 5-10%, and effects are synergistically worse with high saturated fat meals 1
• Uncontrolled diabetes or prediabetes - check HgA1C, as poor glycemic control is often the primary driver 1
• Hypothyroidism - obtain TSH 1
• Medications - review for thiazide diuretics, beta-blockers, estrogen therapy, corticosteroids, antiretrovirals, or antipsychotics 1
• Renal or liver disease - check creatinine and liver enzymes 1

Calculate your 10-year ASCVD risk to determine if pharmacologic therapy will be needed if lifestyle modifications are insufficient. 1

First-Line Treatment: Lifestyle Modifications

Weight Loss (Most Effective Single Intervention)

• Target 5-10% body weight reduction, which produces approximately 20% decrease in triglycerides 1, 2
• In some patients, weight loss alone can reduce triglycerides by 50-70% 1
• Weight loss through caloric restriction combined with increased energy expenditure can reduce triglycerides by approximately 50% 4

Dietary Modifications

• Restrict added sugars to <6% of total daily calories - sugar intake directly increases hepatic triglyceride production 1, 2
• Limit total fat to 30-35% of total daily calories for mild-to-moderate hypertriglyceridemia 1, 2
• Emphasize low-carbohydrate diets over low-fat diets - they are more effective at lowering triglycerides 1
• Consume ≥2 servings (8+ ounces) per week of fatty fish (salmon, trout, sardines, anchovies) 1
• Increase soluble fiber to >10 g/day 1
• Eliminate trans fats completely and restrict saturated fats to <7% of total calories 1

Alcohol Restriction

• Limit alcohol to maximum 1 drink/day for women, or consider complete abstinence 1, 5
• Alcohol significantly raises triglyceride levels and can precipitate marked elevations, especially in those with pre-existing hypertriglyceridemia 1

Physical Activity

• Engage in at least 150 minutes/week of moderate-intensity aerobic activity (or 75 minutes/week vigorous activity) 1, 2
• Regular aerobic training decreases triglycerides by approximately 11% 1
• Moderate to high-intensity physical activity can lower triglycerides by 20-30% 5

Pharmacologic Therapy Decision Algorithm

When to Consider Medication

Statins are the first-line pharmacologic option if: 1, 2

• Your 10-year ASCVD risk is ≥7.5% - initiate at least moderate-intensity statin therapy 1
• Your 10-year ASCVD risk is 5% to <7.5% - engage in patient-clinician discussion regarding statin initiation 1
• You have elevated LDL-C in addition to triglycerides - statins provide 10-30% dose-dependent triglyceride reduction while addressing LDL-C 1, 2

Do NOT start fibrates at this triglyceride level - fibrates are reserved for severe hypertriglyceridemia (≥500 mg/dL) to prevent pancreatitis. 1, 2 At 175 mg/dL, the primary goal is cardiovascular risk reduction, not pancreatitis prevention.

If Triglycerides Remain Elevated After 3 Months

If triglycerides remain >200 mg/dL after 3 months of optimized lifestyle modifications (with or without statin therapy): 1

• Consider adding prescription omega-3 fatty acids (icosapent ethyl 2-4 g/day) 1, 2
• Icosapent ethyl is specifically indicated for patients with triglycerides ≥150 mg/dL on maximally tolerated statin with established cardiovascular disease OR diabetes with ≥2 additional risk factors 1
• Monitor for increased risk of atrial fibrillation with prescription omega-3 fatty acids 1

Monitoring and Follow-Up

• Reassess fasting lipid panel in 6-12 weeks after implementing lifestyle modifications 1, 5, 2
• If starting statin therapy, monitor lipid levels at 4-8 week intervals 1
• Once goals are achieved, follow-up every 6-12 months 1

Critical Pitfalls to Avoid

• Do not ignore secondary causes - treating underlying conditions (especially diabetes, hypothyroidism, or stopping offending medications) may normalize triglycerides without additional lipid therapy 1, 2
• Do not start with fibrates at this level - they are inappropriate for mild hypertriglyceridemia and should be reserved for levels ≥500 mg/dL 1, 2
• Do not use over-the-counter fish oil supplements as substitutes for prescription omega-3 fatty acids - they are not equivalent 1
• Do not delay lifestyle modifications while waiting to see if medication is needed - lifestyle changes are mandatory regardless of whether pharmacotherapy is eventually required 1, 2