II. Pathophysiology

  1. Triglycerides are a major component of serum VLDL
  2. Independent risk factor for Coronary Artery Disease
    1. Triglycerides >500: Increases premature CAD risk by 11.4 fold
    2. Triglycerides >300 and HDL<30: Increases premature CAD risk by 17.2 fold
    3. Type III Dyslipidemia: Increases premature CAD risk by 5-10 fold
    4. (2005) JACC 45:1003-12 [PubMed]

III. Causes

  1. See Serum Triglycerides

IV. Management

  1. General therapeutic lifestyle changes
    1. Reduce body weight
    2. Increase aerobic Exercise
      1. Walking 3-4 miles in approximately 40 minutes daily normalizes Triglycerides within 1 week
      2. Oscai (1972) AJC 30:775-80 [PubMed]
    3. Low Fat Diet
    4. Optimize Blood Sugar control in Diabetes Mellitus
    5. Consider Metabolic Syndrome management
  2. Serum Triglycerides 150 to 199 mg/dl (Borderline high)
    1. Therepeutic lifestyle changes above
    2. Lower LDL Cholesterol to goal (see Hyperlipidemia)
  3. Serum Triglycerides 200 to 499 (high)
    1. Therepeutic lifestyle changes above
    2. Primary goal: Lower LDL Cholesterol
      1. Statin AntiHyperlipidemics
    3. Secondary goal: Lower Triglycerides
      1. Niacin added to Statin
        1. Combination did not show benefit beyond Statin alone in AIM-HIGH study (2011)
        2. Less effect on Triglycerides than fibrate (consider adding fibrate)
      2. Fibrate added to Statin
        1. Tricor (risk of Myopathy when used with Statin)
        2. Gemfibrozil (higher risk of Myopathy than Tricor)
      3. Adjuncts: Fish oil 2-4 g EPA/DHA daily
  4. Serum Triglycerides >500 (very high)
    1. Therepeutic lifestyle changes above
    2. Primary goal is to lower Triglycerides
      1. First-line: Fibrate (Tricor, Gemfibrozil)
      2. Second-line: Niacin with or without Fibrate
      3. Adjuncts: Fish oil 2-4 g EPA/DHA daily
    3. Secondary goal is to lower LDL Cholesterol
      1. Consider adding a Statin to agents above
      2. Use caution due to Myopathy risk
  5. Serum Triglycerides >1000 (highest)
    1. Very Low Fat Diet (<15% of total calories)
    2. Aggressive weight loss
    3. High level of suspicion for secondary cause
    4. Management as fro Serum Triglycerides >500

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Ontology: Hypertriglyceridemia (C0020557)

Definition (CSP) condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV; linked to higher risk of heart disease and arteriosclerosis.
Definition (MSH) A condition of elevated levels of TRIGLYCERIDES in the blood.
Concepts Finding (T033)
MSH D015228
SnomedCT 302870006
English Hypertriglyceridemias, HYPERTRIGLYCERIDAEMIA, HYPERTRIGLYCERIDEMIA, Elevated triglycerides, Triglyceride increased, Raised TG, Raised triglycerides, Hypertriglyceridemia [Disease/Finding], elevated triglycerides, raised triglycerides, high triglycerides, hyperglyceridaemia, increased triglycerides, Hyperglyceridaemia, Hyperglyceridemia, Triglycerides high, Hypertriglyceridaemia, Hypertriglyceridemia (disorder), hyperglyceridemia, Hypertriglyceridemia, hypertriglyceridemia, hypertriglyceridaemia
French HYPERTRIGLYCERIDEMIE, Triglycérides augmentés, Hyperglycéridémie, Elévation des TG, Elévation des triglycérides, Triglycérides élevés, Hypertriglycéridémies, Hypertriglycéridémie
Portuguese HIPERTRIGLICERIDEMIA, Triglicéridos aumentados, Triglicéridos elevados, Triglicéridos altos, Hipergliceridemia, Trigliceridos elevados, Hipertrigliceridemia
Spanish HIPERTRIGLICERIDEMIA, Triglicéridos elevados, Hipergliceridemia, Triglicéridos altos, TG elevados, hipertrigliceridemia (trastorno), hipertrigliceridemia, Elevación de los triglicéridos, Hipertrigliceridemia
German HYPERTRIGLYZERIDAEMIE, Triglyzeride hoch, Hyperglyzeridaemie, vermehrte TG, vermehrte Triglyzeride, Triglyzerid erhoeht, Hypertriglyzeridaemie, Erhoehte Triglyzeride, Hypertriglyzeridämie
Italian Trigliceridi elevati, Trigliceridi aumentati, Trigliceridi alti, Ipergliceridemia, TG aumentati, Ipertrigliceridemia
Dutch hyperglyceridemie, triglyceride verhoogd, triglyceriden hoog, gestegen triglyceriden, gestegen TG, hypertriglyceridemie, verhoogde triglyceriden, Hypertriglyceridemie, Triglyceridemie, hyper-
Japanese トリグリセリド上昇, 高トリグリセリド血症, トリグリセリド増加, 高グリセリド血症, トリグリセリド高値, コウグリセリドケッショウ, トリグリセリドゾウカ, コウグリセリドケツショウ, コウトリグリセリドケツショウ, トリグリセリドコウチ, トリグリセリドジョウショウ, コウトリグリセリドケッショウ
Swedish Hypertriglyceridemi
Czech hypertriglyceridémie, Triglyceridy vysoké, Hypertriglyceridemie, Zvýšené TG, Zvýšené triglyceridy, Triglyceridy zvýšené, Triglycerid zvýšený
Finnish Hypertriglyseridemia
Polish Hipertrójglicerydemia, Hipertriglicerydemia, Podwyższony poziom triglicerydów we krwi
Hungarian Megemelkedett trigliceridek, Hypertriglyceridaemia, Triglycerid emelkedett, TG megemelkedett, Hyperglyceridaemia, Trigliceridek megemelkedett, Triglyceridek magas
Norwegian Hypertriglyseridemi