Definitions,
Physical Features,
and Complications of Hypertriglyceridemia

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Consensus
Definitions of Plasma
Triglyceride Levels

Consensus Definitions of Plasma Triglyceride Levels

MODERATELY ELEVATED
TG LEVELS
(>1.7 mmol/L; >150 mg/dL)

There is now consensus that moderately elevated plasma TG level is causally related to clinically relevant risk of atherosclerotic cardiovascular disease (ASCVD) which may be due to TG, triglyceride-rich lipoproteins (TRLs) and/or TRL remnants.1,2,11,31

“Plasma TG varies over a wide range in the population, and as levels rise, the risk of atherosclerotic cardiovascular disease increases continuously”
European Atherosclerosis Society consensus statement, 2021

Furthermore, people with severe hypertriglyceridemia (TG 5.7-10.0 mmol/L; 500-1,000 mg/dL) may experience unrecognized marked increases in TG levels (>10 mmol/L), leading to acute pancreatitis.23

Hypertriglyceridemia can occur as part of the metabolic syndrome and complicate the management of obesity, diabetes, and insulin resistance.2,4,13

Moderate and severe HTG are associated with increases in the hazard for myocardial infarction, ischemic heart disease, and ischemic stroke.
Moderate and severe HTG are associated with increases in the hazard for myocardial infarction, ischemic heart disease, and ischemic stroke.

Older literature refers to the risk of AP appearing only above non-fasting TG levels of 10 mmol/L, but recent studies indicate that the risk of acute pancreatitis increases in a dose-dependent manner even within the range of moderately elevated TG levels (eg, non-fasting >2.0 mmol/L)4,10

Even moderate HTG is associated with increased hazard for acute pancreatitis.
Even moderate HTG is associated with increased hazard for acute pancreatitis.

Severe and Extreme HTG

Untreated severe or
extreme HTG is associated with:12,14,21,22

  • Recurrent episodes of acute pancreatitis
  • Hospitalization including ICU stays (5-8% in uncomplicated acute pancreatitis)
  • Increased risk of mortality
  • Persistent organ failure
  • Significant interference with patients' lives, social relationships, and activities

Common physical features and complications of severe or extreme HTG

Cardiovascular disease

TG levels of 500-799 mg/dL are independently associated with further increases in the risk of CV disease above the risk associated with TG levels of 150-499 mg/dL.32

Overall, people with severe or extreme HTG have approximately 2-fold to 9-fold higher risk of MI, stroke, aortic stenosis or other major adverse cardiovascular events compared to those with normal TG levels.1,9,24,32

A small percentage of HTG patients have familial chylomicronemia syndrome (FCS). Several observational studies have reported no increase in CV risk in these patients.16

Non-alcoholic fatty liver disease (NAFLD)

Elevated plasma TG levels are a risk factor for development of NAFLD,26-28 which can progress to non-alcoholic steatohepatitis and cirrhosis.7 As many as three-in-four people with extreme HTG levels may develop NAFLD.29

People with extreme HTG (chylomicronemia) may
also exhibit the following symptoms

Acute pancreatitis

People with TG levels ≥ ~500 mg/dL have an 11-fold higher risk for acute pancreatitis compared to the general population and those with genetically influenced sHTG have an even higher risk, ~50-fold. 10,14

Acute pancreatitis is fatal in 5-8% of uncomplicated cases and as many as 30% of complicated cases. It is also associated with an increased risk of persistent organ failure, endocrine and exocrine pancreatic insufficiency, and type 3C diabetes mellitus.12,21,25

Recurrent abdominal pain

Single or recurrent episodes of generalized abdominal pain, which can be incapacitating.14

Eruptive xanthoma

Transient eruptive cutaneous xanthomas affect some individuals with extreme HTG and typically affect the trunk and extremtities. Xanthomas are often not recognized or mistaken for other skin conditions.12

Hepatosplenomegaly

Hepatomagaly, splenomegaly, or both occur in some people with extreme HTG.12

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    SHOW REFERENCES

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    2. Virani SS, Morris PB, Agarwala A, et al. 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021.

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