A New Guideline for Treating Hypertriglyceridemia

Author Information (click to view)

Lars Berglund MD, PhD

Professor of Medicine
Senior Associate Dean for Research
Director, Clinical and Translational Science Center
University of California, Davis Health System

Lars Berglund, MD, PhD, has indicated to Physician’s Weekly that he has served as a consultant for Merck and Danone and received grants/research aid from the NIH. He is also a shareholder of Pfizer and Novo Nordisk.

Figure 2 (click to view)

Lars Berglund MD, PhD (click to view)

Lars Berglund MD, PhD

Professor of Medicine
Senior Associate Dean for Research
Director, Clinical and Translational Science Center
University of California, Davis Health System

Lars Berglund, MD, PhD, has indicated to Physician’s Weekly that he has served as a consultant for Merck and Danone and received grants/research aid from the NIH. He is also a shareholder of Pfizer and Novo Nordisk.

The Endocrine Society has released a clinical practice guideline on hypertriglyceridemia that stresses the importance of individualizing treatments based on patient factors.

Hypertriglyceridemia can substantially increase the likelihood of patients developing heart disease when compared with those who have normal triglyceride levels. While treatment strategies for this condition are well established, its causes differ from patient to patient, as do the risks they pose to each individual. Clinical practice guidelines from the Endocrine Society on hypertriglyceridemia were published in the September 2012 Journal of Clinical Endocrinology and Metabolism (view and print guideline summary here). They recommend that more attention be paid to how personal history, physiology, and lifestyle interact to affect risk.

“In recent years, much of the focus surrounding lipids has concentrated on cholesterol,” explains Lars Berglund, MD, PhD, who chaired the Endocrine Society task force that developed the most recent guidelines. “Although there are evidence–based guidelines from respected medical associations that address lipids, data on the complex role of triglycerides in heart disease continue to accumulate. Considering this recent emergence of data on triglycerides, it was important to focus on a guideline that specifically discusses this component of heart disease care.”

Individualized Approach with Elevated Triglycerides

Dr. Berglund stresses that clinicians should not view elevated fasting triglyceride levels as a standalone factor. “Triglycerides should be looked at in the context of other risk factors for cardiovascular disease (CVD) and metabolic disease,” he says. “Assessment should include the evaluation of secondary causes of hyperlipidemia, including endocrine conditions and medications [Table 1]. Central obesity, hypertension, abnormalities of glucose metabolism, liver dysfunction, and family history of dyslipidemia and CVD should be assessed.” For example, patients with triglyceride levels in the moderate range—200 mg/dl to 999 mg/ dl—may have changes in HDL and LDL cholesterol levels and properties, which are associated with cardiovascular risk, but insulin resistance and other factors should also be considered during patient management. Patients with isolated hypertriglyceridemia (eg, familial type) are more likely to have larger particles, which are less likely to cause cardiovascular risk.

Fatty foods, smoking, and poor exercise also contribute to the risk for high triglyceride levels. “Simple carbohydrates that can be broken down and absorbed quickly, such as sugar-sweetened beverages, white rice, and white bread, contribute to an increase in fat formation and triglyceride levels,” says Dr. Berglund. While alcohol can increase HDL cholesterol levels, it can also lead to high triglyceride levels. Certain prescription medications (eg, bile acid sequestrants for high LDL) can also interact to raise blood triglyceride levels. “Understanding the importance of specific risk factors requires that clinicians ascertain a full profile of each patient,” Dr. Berglund adds.

Considering Treatment Options for Hypertriglyceridemia

Defining the level of hypertriglyceridemia for individual patients is crucial to determining the goal of treatment and should be based on fasting levels. The Endocrine Society guidelines define normal triglyceride levels as less than 150 mg/dl (Table 2). Mild and moderate hypertriglyceridemia are categorized by levels below 999 mg/dl, which are primarily associated with a risk for CVD. When levels rise above 1,000 mg/ dl, patients should be categorized as having severe and very severe hypertriglyceridemia. The risk for these individuals is associated more often with pancreatitis.

Because weight, diet, and exercise play particularly important roles in triglyceride levels, the Endocrine Society guideline recommends that initial treatment for mild-to-moderate hypertriglyceridemia be lifestyle therapy, consisting of dietary counseling, physical activity, and a weight reduction program for overweight and obese patients. “Overweight or obese patients may feel overwhelmed when asked to lose weight,” Dr. Berglund says, “but clinicians should reassure them that even modest reductions in weight can have highly beneficial effects on their triglyceride levels.”

For patients at risk for triglyceride-induced pancreatitis and for whom lifestyle changes have been ineffective, the guideline recommends that fibrates be used as the first-line of drug treatment. Although statins have some triglyceride-lowering effects, they are not overly effective in patients with very high levels, according to Dr. Berglund. The guideline recommends that statins not be used as monotherapy for severe or very severe hypertriglyceridemia, but may be useful for moderate hypertriglyceridemia when indicated to modify cardiovascular risk. Fibrates, niacin, and n-3 fatty acids are recommended for use alone or in combination with statins in patients with moderate-to-severe triglyceride levels.

“The key take-home message for all clinicians is that patients with high triglyceride levels need to be evaluated for secondary causes on an individualized basis,” says Dr. Berglund. “Only then can we determine the causes and direct our focus of treatment. The Endocrine Society guidelines can serve as a helpful aid for physicians as they manage patients from diagnosis to treatment.”

Readings & Resources (click to view)

Berglund L, Brunzell J, Goldberg A, et al. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:2969-2989.

Ford E, Li C, Zhao G, et al. Hypertriglyceridemia and its pharmacologic treatment among US adults. Arch Intern Med. 2009;169:572-578.

Di Angelantonion E, Sarwar N, Perry P, et al. Major lipids, apolipoproteins, and risk ofvascular disease. JAMA. 2009;302:1993-2000.

Muller-Riemenschneider F, Nocon M, Willich S. Prevalence of modifiable cardiovascular risk factors in German adolescents. Eur J Cardiovasc Prev Rehabil. 2010;17:204-210.

Mora S, Rifai N, Buring J, Ridker P. Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events. Circulation. 2008;118:993-1001.

Stalenhoef A, de Graaf J. Association of fasting and nonfasting serum triglycerides with cardiovascular disease and the role of remnant-like lipoproteins and small, dense LDL. Curr Opin Lipidol. 2008;19:355-361.


  1. I’m 6’2″ @215 lb and practice Brazilian Jiu Jitsu twice a week. My fasting, untreated triglyceride levels are 2000-2500 (peak… diagnosed in my late 20s) with paternal family history of congestive heart failure (dad had hypertension, hi cholesterol, pre-diabetic and was very overweight). My treated (gemfibrozil 600mg twice daily) triglyceride levels lately are still ~750-1000. I’ve had 2 attacks of pancreatitis in the past year and I don’t drink soda or alcohol at all. I’m in pretty good shape overall and would like to understand what’s happening with me. My good cholesterol is low but bad is fine. I have low bloodpressure overall and main arteries are clear so far. I’m a 47 year old caucasian male.

    • I am 44 years old non practicing doctor with no family history. I randomly checked my Fasting Glucose and did lipid profile (fasting). My weight was 80 Kg and height is 5’10. On receipt of my reports I went in depression for almost a week. My reports were as follows:
      Fasting Glucose 197
      Cholesterol 270
      Triglycerides 800
      HDL 34
      LDL 60

      I went for HBA1c which came out at 7.5%

      My doctor prescribed Glucophage and Fibrates plus of course lifestyle changes and diet. I am a smoker.

      I started working out with medications and diet.
      After 3 months my results didnt budge much. I went into extreme depression.

      Now this is an interesting point … I am an Asian from Pakistan and our food is almost always rich with fats, white bread, meat and sweets. Its impossible to avoid this food but i did. Someone suggested a herbal mixture which is to be made at home with certain ingredients. It is unbelievable but following are my results aftet 6 months:
      HBA1c 5.7%
      Choleaterol 156
      Triglycerides 280

      Unbelievable!! I am no more on strict diet but i have cut sugar almost 100%. The rest I eat as normal. Of course I have added religiously a workout of brisk walk for 60 minutes 7 days a week.

      If u need that product i can provide u without charge.

      To be specific I believe herbal is the most effective way to fight this phenomenon.
      P.S. I still take Glucophage and a Fibrate.
      Dr S Faisal Bukhari
      +92-300-8495959 (whatsapp)

      • Please let me know how to make the herbal powder. I have hyper triglycerides.

  2. I have familial hypertriglyceridemia. My levels are quiet high..1600. Suffered acute pancreatitis twice. Plz suggest wether i must go for allopathy, homeopathy or ayurvedic treatment?

    • with this level you should be on drugs. See endocrinologist. Talk to you doctor about familial hypercholesterolemia (HoFH)

  3. The best most effective way to lower high Trigs is Vascepa (96% pure EPA) can get prescription from your general practitioner. It’s newer and way better then Livaza which raises bad LDL cholesterol and has a risk of atril fibulation. And of course better then any weak unregulated yet more expensive over the counter fish oil supplements. take just 2 Vascepa a day and your Trigs will be be down to a healthy level within a couple weeks to a month not to mention all the other health benefits with no side effects at all.

  4. My triglyceride lavel is 275 and my BP is often at 130/90 what can i do.
    I m a cricketer and iplay everyday almost 1hr.
    Have i need any medication .

  5. I do exercise for 45 minutes and play regularly for an hour in spite of that my triglyceride comes high. Recently it has come to 860.
    I do consume alcohol daily abt 180 ml otherwise my dietary habits are good.

    • your tg are high u need to cut down ur alcohol and check your diabetic status once.and i suggest that u cut down the fat intake in ur diet and take fish oil supplementation.its better if u could follow up with a doctor and follow treatment .


Submit a Comment

Your email address will not be published. Required fields are marked *

19 − eleven =