What does it mean to have elevated triglycerides (hypertriglyceridemia)?

From the Guidelines

Elevated triglycerides are a significant risk factor for cardiovascular disease, and managing them is crucial to reduce the risk of heart disease, stroke, and pancreatitis, especially when levels exceed 500 mg/dL. To understand the implications of elevated triglycerides, it's essential to consider the latest evidence. According to the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1, regular physical activity, such as aerobic exercise, can help reduce triglyceride levels by up to 11%.

Key Points to Consider

• Elevated triglycerides are associated with a sedentary lifestyle, visceral adiposity, and reduced oxidation of muscle fatty acids 1.
• The current recommendation for physical activity for adults is to engage in at least 150 minutes per week of accumulated moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity to reduce ASCVD risk 1.
• Combined physical activity and weight loss, such as a 5% to 10% body weight reduction, can result in up to a 20% reduction in triglycerides 1.
• Dietary changes, including reducing sugar and refined carbohydrate intake, limiting alcohol, and eating more omega-3 rich foods like fatty fish, are also essential for managing elevated triglycerides 2, 3.

Management Strategies

• For levels above 500 mg/dL, medications may be necessary, such as fibrates (fenofibrate, gemfibrozil), omega-3 fatty acids (prescription-strength fish oil like Vascepa or Lovaza at 2-4g daily), or statins 3.
• Regular monitoring through blood tests is essential to track progress in bringing levels back to normal 2.
• It's crucial to address other cardiovascular risk factors, such as central obesity, hypertension, abnormal glucose metabolism, and liver dysfunction, in patients with primary hypertriglyceridemia 3.

By prioritizing the latest and highest-quality evidence, managing elevated triglycerides through a combination of lifestyle changes and, if necessary, medication, is essential to reduce the risk of cardiovascular disease and improve overall health outcomes.

From the FDA Drug Label

Markedly elevated levels of serum triglycerides (e.g., > 2,000 mg/dL) may increase the risk of developing pancreatitis.

• Elevated triglycerides mean that the level of triglycerides in the blood is higher than normal.
• This can increase the risk of developing pancreatitis, a potentially serious condition.
• The FDA drug label for fenofibrate indicates that severely elevated triglycerides (above 2,000 mg/dL) may pose this risk 4.

From the Research

Definition and Risks of Elevated Triglycerides

• Elevated triglycerides, also known as hypertriglyceridemia, affect approximately 33% of the US population 5.
• Hypertriglyceridemia is independently associated with cardiovascular disease (CVD) risk, and severe hypertriglyceridemia is a risk factor for acute pancreatitis 5.
• Elevated triglyceride levels are often associated with other CVD risk factors, such as obesity, insulin resistance, diabetes mellitus, low HDL cholesterol, lifestyle factors, and changes in lipoprotein size and density 6.

Treatment and Management of Hypertriglyceridemia

• Guidelines for the management of severe hypertriglyceridemia recommend immediate use of triglyceride-lowering agents, while statins remain the first line of therapy for the management of mild to moderate hypertriglyceridemia 5.
• Treatment of elevated triglycerides in clinical trials has been shown to reduce CVD events, cardiac deaths, and total mortality 6.
• Omega-3 fatty acids and fenofibrate are both used to treat patients with hypertriglyceridemia, with fenofibrate therapy having substantially better effects on lipoprotein and metabolic profiles in patients with hypertriglyceridemia 7.

Effects of Omega-3 Fatty Acids and Fenofibrate on Triglyceride Levels

• Omega-3 fatty acids therapy decreased triglycerides by 21% and improved flow-mediated dilation 7.
• Fenofibrate therapy decreased triglycerides by 29% and improved flow-mediated dilation, while also decreasing non-HDL cholesterol and increasing HDL cholesterol and apolipoprotein AI 7.
• The addition of omega-3 fatty acids to stable fenofibrate therapy resulted in a statistically significant reduction in triglyceride levels 8.

Importance of Managing Hypertriglyceridemia

• Primary care professionals are well positioned to appropriately evaluate and manage hypertriglyceridemia, improving overall health outcomes 9.
• Elevated triglycerides are independently associated with increased atherosclerotic cardiovascular disease risk, making it essential to manage and treat hypertriglyceridemia effectively 9.