Expert management recommendations

Expert organizations, including the American Heart Association, American College of Cardiology, National Lipid Association, and Endocrine Society, emphasize the importance of lowering fasting triglyceride levels that are 
>500 mg/dL to reduce associated risks. Achieving this requires 
carefully addressing related comorbidities.1-4

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Expert guidance

Expert guidelines and recommendations underscore the urgent need to lower triglyceride levels that are >500 mg/dL1-4

American Heart Association

has detailed in an advisory that the primary goal of therapy is to reduce triglycerides to <500 mg/dL1
American College of Cardiology

has stated that for patients with triglyceride levels
≥500 mg/dL, the priority is lowering triglycerides to reduce the risk of pancreatitis2
National Lipid Association

has stated that the primary objective for treating patients with severe triglyceride elevation
(≥500 mg/dL) is to reduce the risk of pancreatitis through nutrition and other lifestyle interventions, as well as pharmacotherapy when appropriate; atherosclerotic cardiovascular disease (ASCVD) risk reduction follows in priority3
Endocrine Society

has recommended that adults with fasting triglycerides
>500 mg/dL receive pharmacologic treatment as an adjunct to diet and exercise to prevent pancreatitis4

Metabolic considerations

In the constellation of metabolic burdens, severe hypertriglyceridemia (sHTG) is a distinct risk that demands action2,3

Obesity2

Insulin
resistance2

Type 2
diabetes2
sHTG2
High LDL3
Low HDL3

HDL=high-density lipoprotein; LDL=low-density lipoprotein.

Disorders along the MASLD/MASH spectrum often coexist 
with sHTG, compounding overall metabolic disease burden5,6

Shadows of people with text overlay "Among US adults with sHTG, up to 67% have MASLD, part of the MASLD/MASH spectrum"

The prevalence of hepatic steatosis was 2- to 3-fold higher in sHTG than in the general population5,7

When managing sHTG, it is important to consider interrelated metabolic conditions such as those along the MASLD/MASH spectrum.5,6

MASH=metabolic dysfunction-associated steatohepatitis; MASLD=metabolic dysfunction-associated steatotic liver disease.

References

References

  1. Skulas-Ray AC, Wilson PWF, Harris WS, et al. Omega-3 fatty acids for the management of hypertriglyceridemia: a science advisory from the American Heart Association. Circulation. 2019;140(12):e673-e691.

  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;78(9):960-993.

  3. Kirkpatrick CF, Sikand G, Petersen KS, et al. Nutrition interventions for adults with dyslipidemia: a clinical perspective from the National Lipid Association. J Clin Lipidol. 2023;17(4):428-451.

  4. Newman CB, Blaha MJ, Boord JB, et al. Lipid management in patients with endocrine disorders: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2020;105(12):3613-3682.

  5. Gurevitz C, Chen L, Muntner P, Rosenson RS. Hypertriglyceridemia and multiorgan disease among U.S. adults. JACC Adv. 2024;3(5):100932.

  6. Friedman SL. Fat, fibrosis, and the future: navigating the maze of MASLD/MASH. J Clin Invest. 2025;135(7):e186418. Published 2025 Apr 1. doi:10.1172/JCI186418

  7. De Villers-Lacasse A, Paquette M, Baass A, Bernard S. Non-alcoholic fatty liver disease in patients with chylomicronemia syndromes. J Clin Lipidol. 2023;17(4):475-482.

  8. Santos-Baez LS, Ginsberg HN. Hypertriglyceridemia—causes, significance, and approaches to therapy. Front Endocrinol (Lausanne). 2020;11:616.