Hypertriglyceridaemia

Hypertriglyceridaemia is a condition where you have too much of a type of fat called triglycerides in your blood. This condition affects about 1 in 5 adults and can raise your risk of heart disease and, at very high levels, inflammation of the pancreas.

Table of contents

• What is hypertriglyceridaemia?
• Understanding triglyceride levels
• What causes high triglycerides?
• Signs and symptoms
• How is it diagnosed?
• Treatment options
• Lifestyle changes
• Medications
• Potential complications

What is hypertriglyceridaemia?

Hypertriglyceridaemia is a condition in which you have too many triglycerides (a type of fat) in your blood^[1]. Triglycerides are important fats that provide energy to your body. You get some triglycerides from foods you eat, like butter and oils. When you consume more calories than your body needs right away, it converts them into triglycerides and stores them in your fat cells. Your body can access these stored triglycerides later when you need energy^[1].

While triglycerides serve an important function, having too many of them in your blood raises your risk of cardiovascular disease (diseases affecting the heart and blood vessels)^[1]. In most cases, hypertriglyceridaemia happens when there is too much production or not enough removal of triglyceride-rich lipoproteins (particles that carry fats through the bloodstream)^[8].

Hypertriglyceridaemia is not the same as high cholesterol, though many people have both conditions^[1]. Both triglycerides and cholesterol are types of fats that travel through your blood, but your body uses them differently. Triglycerides provide fuel, while cholesterol is needed for making certain hormones and building cells.

Understanding triglyceride levels

Triglyceride levels are measured through a blood test, usually while you are fasting. A normal triglyceride level in adults is below 150 milligrams per deciliter (mg/dL). A level below 100 mg/dL is considered ideal^[1].

Healthcare professionals classify triglyceride levels as follows^[1][3]:

• Normal: Under 150 mg/dL
• Borderline high: 150 to 199 mg/dL
• High: 200 to 499 mg/dL
• Very high: 500 mg/dL or higher

The target range is different for children and teens. The normal fasting triglyceride level in children ages 10 to 19 is below 90 mg/dL^[1].

When triglycerides reach 500 mg/dL or higher, this is called severe hypertriglyceridaemia. People with severe hypertriglyceridaemia face an increased risk of acute pancreatitis (sudden inflammation of the pancreas that requires medical care)^[1].

What causes high triglycerides?

Hypertriglyceridaemia is usually caused by multiple factors working together^[2]. The causes can be divided into primary (genetic) and secondary (acquired) causes.

Primary causes include genetic conditions such as familial hypertriglyceridaemia, familial combined hyperlipidemia, and rare disorders like lipoprotein lipase deficiency^[2]. These genetic conditions affect how your body processes triglycerides.

Secondary causes are much more common and include^[2][8]:

• Obesity and being overweight
• Type 2 diabetes and poor blood sugar control
• Metabolic syndrome
• Excessive alcohol consumption
• Diets high in saturated fat and sugar
• Physical inactivity
• Kidney disease
• Hypothyroidism (underactive thyroid)
• Certain medications, including beta blockers, diuretics, steroids, oral estrogen, and some chemotherapy drugs

About 1 in 5 adults in the United States have elevated triglyceride levels above 150 mg/dL. The risk increases with age, affecting 42% of adults age 60 and above^[1].

Signs and symptoms

Most people with hypertriglyceridaemia have no symptoms^[1][4]. The condition is often discovered during routine blood tests. However, people with very high triglyceride levels may develop visible signs.

When triglycerides are extremely elevated, some people develop xanthomas (fatty deposits under the skin that appear as small bumps)^[1][5]. These are typically 2 to 5 millimeter bumps, often with a red ring around them, that appear in clusters on the trunk, buttocks, and arms and legs. In some genetic forms of the condition, larger, tuberous xanthomas may appear on the elbows and knees, and yellowish deposits may appear in the creases of the palms^[5].

Other signs that may appear with severe hypertriglyceridaemia include^[4]:

• Lipemia retinalis (a milky appearance of blood vessels in the eye)
• Corneal arcus (a grayish ring around the colored part of the eye)
• Enlarged liver and spleen

When triglyceride levels reach very high levels (above 1,000 mg/dL), there is a risk of developing acute pancreatitis. Symptoms of pancreatitis include severe pain in the upper abdomen or mid-back area, nausea, and vomiting^[3][5].

How is it diagnosed?

Hypertriglyceridaemia is diagnosed through a blood test that measures triglyceride levels^[8]. This test is usually part of a routine lipid panel (a group of blood tests that measure different types of fats in your blood), which also measures cholesterol levels.

The test is typically done after fasting for 10 to 12 hours, as eating can temporarily raise triglyceride levels^[4][6]. However, in some situations, non-fasting triglyceride levels may be measured^[8].

If high triglycerides are found, your healthcare provider will conduct additional evaluations to determine the cause. This includes^[8]:

• A physical examination to check for xanthomas and other signs
• Review of your medical history, medications, diet, exercise habits, and family history
• Additional blood tests to check for diabetes, kidney disease, and thyroid problems
• Assessment for metabolic syndrome and cardiovascular risk factors

It’s important to remember that triglyceride levels can vary from day to day in the same person^[15]. Your doctor may repeat the test to confirm the diagnosis.

Treatment options

The approach to treating hypertriglyceridaemia depends on how high your triglyceride levels are and your overall risk for heart disease^[3]. Treatment has two main goals: preventing heart disease in people with mild to moderate elevation and preventing pancreatitis in people with very high levels.

For people with borderline high (150 to 199 mg/dL) and high (200 to 499 mg/dL) triglyceride levels, treatment focuses on lifestyle changes and reducing overall cardiovascular risk. Your healthcare provider will calculate your 10-year risk of heart disease to determine whether medications are needed^[3].

For people with very high triglycerides (500 mg/dL or higher), rapid lowering is important to prevent pancreatitis. These individuals typically need both lifestyle changes and medications^[2][3].

Any underlying conditions that contribute to high triglycerides should also be treated. This means controlling blood sugar if you have diabetes, treating thyroid problems if present, and reviewing medications that might be raising your triglyceride levels^[10].

Lifestyle changes

Lifestyle changes are the foundation of managing hypertriglyceridaemia^[2][13]. These changes can be highly effective, with dietary changes in some cases reducing triglycerides by more than 70%^[21].

Weight loss: Losing just 5% to 10% of your body weight can lower triglycerides by about 20%^[21]. Weight loss is particularly important if you are overweight or obese.

Dietary changes: Several dietary approaches can help lower triglycerides^[3][13][21]:

• Reduce intake of simple carbohydrates, especially refined carbohydrates and added sugars
• Avoid sugar-sweetened beverages
• Limit or eliminate alcohol consumption
• Reduce intake of desserts and sweets
• Choose whole, fresh fruits instead of fruit juices
• Eat more fish, especially fatty fish like salmon, trout, and tuna (aim for two servings per week, about 8 ounces total)
• Increase intake of omega-3 fatty acids
• Follow a diet rich in vegetables, whole grains, and lean proteins

If your triglycerides are very high (above 500 mg/dL), you may need to lower your overall fat intake, including choosing leaner types of seafood^[21].

Physical activity: Regular aerobic exercise can lower triglyceride levels by 6% to 11% and also reduces the rise in triglycerides that occurs after eating^[13]. Moderate to high-intensity physical activity also improves body composition and exercise capacity^[3]. Aim for regular aerobic activity most days of the week.

Stop smoking: If you smoke, quitting is important for your overall cardiovascular health^[9].

Medications

When lifestyle changes are not enough to control triglyceride levels, medications may be needed. The choice of medication depends on your triglyceride level, cholesterol levels, and cardiovascular risk^[9][10].

Statins: These medications are primarily used to lower LDL (“bad”) cholesterol, but they can also reduce triglycerides by 20% to 40%^[9]. Statins are often the first medication prescribed for people with high triglycerides who also have elevated LDL cholesterol or high cardiovascular risk.

Fibrates: These medications can reduce triglycerides by 40% to 60% and are particularly useful for people with very high triglycerides^[9]. Common fibrates include fenofibrate and gemfibrozil. These medications should be considered for people with triglyceride levels of 500 mg/dL or higher to reduce the risk of pancreatitis^[3].

Omega-3 fatty acids: High doses (2 to 4 grams daily) of prescription omega-3 fatty acids can lower triglyceride levels^[9]. A specific prescription form called icosapent (purified eicosapentaenoic acid) at a dose of 4 grams daily has been shown to reduce cardiovascular death in high-risk patients already taking statins^[3][13].

Niacin: This B vitamin can reduce triglycerides by 30% to 50% and also raises HDL (“good”) cholesterol^[9]. However, it can cause side effects including flushing and may worsen blood sugar control in people with diabetes.

In some cases, a combination of medications may be necessary^[9]. Your healthcare provider will work with you to find the best treatment approach based on your individual situation.

For people with extremely rare genetic conditions causing very high triglycerides (familial chylomicronemia syndrome), specialized treatment in expert clinics is recommended^[15].

Potential complications

Cardiovascular disease: Elevated triglycerides are associated with an increased risk of heart attack and stroke^[2][7]. This risk is particularly high when high triglycerides occur together with low HDL (“good”) cholesterol and high LDL (“bad”) cholesterol. High triglycerides contribute to atherosclerosis (the buildup of fatty deposits in blood vessel walls), which can lead to heart disease^[1].

Acute pancreatitis: When triglyceride levels reach very high levels (typically above 1,000 mg/dL), there is a significant risk of developing acute pancreatitis^[1][3]. Hypertriglyceridaemia accounts for 1% to 10% of all cases of acute pancreatitis^[12]. In pregnant women with pancreatitis, hypertriglyceridaemia may be the underlying cause in more than half of cases^[12].

If pancreatitis develops in someone with very high triglycerides and conservative treatment is not effective, additional treatments may be needed. These can include insulin infusion or plasmapheresis (a procedure to remove triglycerides from the blood) if triglyceride levels remain at 1,000 mg/dL or higher^[3][12].