Identifying patients with severe hypertriglyceridemia (sHTG)

Early identification is essential to effective management of sHTG. Timely intervention can help reduce serious risks such as acute pancreatitis (AP). Explore these patient profiles to see how sHTG may appear in your practice.1,2

Patient profiles

Managing severe hypertriglyceridemia (sHTG) starts with prompt patient identification

Choose a patient journey to explore

portrait of sHTG patient model named Sandra

She experienced her first AP attack. Will there be another?

Sandra
portrait of sHTG patient model named Lawrence

His diabetes and triglycerides were out of control.

Lawrence
portrait of sHTG patient model named Michael

His cardiologist suspected there was more to his sHTG.

Michael
portrait of sHTG patient model named Maria

When the standard of care isn't working, it's time to dig deeper.

Maria

Not real patients; actor portrayals and generated models.

Portrait of sHTG patient model named Sandra with quote: I want my life back
"I want my life back."
Not a real patient; actor portrayal or generated model.

Sandra, 49

Has sHTG with a history of acute pancreatitis (AP)

Not a real patient; actor portrayal or generated model.
  • Diagnosed with sHTG at 47 (fasting TGs of 664 mg/dL and 773 mg/dL)
  • Started on a fibrate but stopped due to myalgias
  • AP event at 48
  • Was prescribed omega-3 fatty acid and a statin along with lifestyle modifications, but TGs remained ≥500 mg/dL
  • Remains anxious about another AP event if TGs aren't lowered significantly
"I want my life back."
  • Diagnosed with sHTG at 47 (fasting TGs of 664 mg/dL and 773 mg/dL)
  • Started on a fibrate but stopped due to myalgias
  • AP event at 48
  • Was prescribed omega-3 fatty acid and a statin along with lifestyle modifications, but TGs remained ≥500 mg/dL
  • Remains anxious about another AP event if TGs aren't lowered significantly
TG levels 500-880 mg/dL (fasting)
TG levels of 500-880 mg/dL are associated with an increased risk of AP, especially when there's a history of AP1,3-5
Intolerant to fibrates, and TG level not at goal despite statin and omega-3 fatty acid therapy
Statins, fibrates, and omega-3 fatty acids do not reduce triglyceride levels sufficiently in all patients with sHTG6,7
Overweight with a BMI of 29.7 kg/m2
sHTG is commonly associated with comorbidities such as obesity1,8
History of AP with hospitalization
Once a patient with sHTG has had an episode of AP, the risk for future episodes significantly increases5
Is there more that can be done to lower Sandra’s TGs and decrease the risk of another AP episode?
portrait of sHTG patient model named Lawrence with quote: I want to turn my health around for my family
"I want to turn my health around for my family."
Not a real patient; actor portrayal or generated model.

Lawrence, 62

Has sHTG and type 2 diabetes mellitus (T2DM)

Not a real patient; actor portrayal or generated model.
  • Under the care of an endocrinologist for diabetes and on metformin for many years
  • Recently started on a statin and lifestyle modifications to lower TGs
  • A1c improved but TGs persisted in the range of 789 mg/dL to 873 mg/dL (fasting)
  • Was prescribed omega-3 fatty acid, and later a fibrate, but TGs remained ≥500 mg/dL
  • Was prescribed a GLP-1 receptor agonist, which achieved weight loss and better glycemic control but showed limited TG reduction
  • Worries his endocrinologist won't find a more effective therapy to lower his TGs adequately, leaving him at risk for AP
"I want to turn my health around for my family."
  • Under the care of an endocrinologist for diabetes and on metformin for many years
  • Recently started on a statin and lifestyle modifications to lower TGs
  • A1c improved but TGs persisted in the range of 789 mg/dL to 873 mg/dL (fasting)
  • Was prescribed omega-3 fatty acid, and later a fibrate, but TGs remained ≥500 mg/dL
  • Was prescribed a GLP-1 receptor agonist, which achieved weight loss and better glycemic control but showed limited TG reduction
  • Worries his endocrinologist won't find a more effective therapy to lower his TGs adequately, leaving him at risk for AP
TG levels 500-880 mg/dL (fasting)
TG levels of 500-880 mg/dL are associated with an increased risk of ASCVD and AP1,3,4
TG level not at goal despite statin, fibrate, omega-3 fatty acid therapy, and GLP-1
Statins, fibrates, omega-3 fatty acids, and GLP-1s do not reduce triglyceride levels sufficiently in all patients with sHTG6,7,9
Obese with a BMI of 36 kg/m2
sHTG is commonly associated with comorbidities such as obesity1,8
T2DM is well managed
sHTG is commonly associated with comorbidities such as diabetes1,8
Is there more that can be done to lower Lawrence’s TGs and reduce the risk of AP?
portrait of sHTG patient model named Michael with quote: I'm tired of living like this. It's time to make a change
"I’m tired of living like this. It’s time to make a change."
Not a real patient; actor portrayal or generated model.

Michael, 58

Has sHTG and hypertension, and was diagnosed with multifactorial chylomicronemia syndrome (MCS)

Not a real patient; actor portrayal or generated model.
  • Has been on an ACE inhibitor for hypertension, and a statin
  • Fasting TGs 650 mg/dL 
  • Cardiologist prescribed strict diet
  • Complained of intermittent abdominal discomfort and difficulty adhering to the diet at 6-week follow-up
  • Repeat lipid panel showed TG level of 1500 mg/dL (fasting)
  • Started on an omega-3 fatty acid, and later a fibrate, but TGs remained >880 mg/dL
  • Cardiologist used NAFCS scoring tool to rule out FCS, a monogenic genetic form of sHTG10,11
  • Was diagnosed with MCS, a polygenic form of sHTG, commonly seen with comorbid conditions11,12
"I’m tired of living like this.
It’s time to make a change."
  • Has been on an ACE inhibitor for hypertension, and a statin
  • Fasting TGs 650 mg/dL 
  • Cardiologist prescribed strict diet
  • Complained of intermittent abdominal discomfort and difficulty adhering to the diet at 6-week follow-up
  • Repeat lipid panel showed TG level of 1500 mg/dL (fasting)
  • Started on an omega-3 fatty acid, and later a fibrate, but TGs remained >880 mg/dL
  • Cardiologist used NAFCS scoring tool to rule out FCS, a monogenic genetic form of sHTG10,11
  • Was diagnosed with MCS, a polygenic form of sHTG, commonly seen with comorbid conditions11,12
TG levels intermittently >880 mg/dL (fasting)
TG levels >880 mg/dL are associated with a significant risk of AP1,3,4
TG level not at goal despite statin, fibrate, and omega-3 fatty acid therapy
Statins, fibrates, and omega-3 fatty acids do not reduce triglyceride levels sufficiently in all patients with sHTG6,7
Overweight with a BMI of 29 kg/m2
sHTG is commonly associated with comorbidities such as obesity1,8
Has well-controlled hypertension
sHTG is commonly associated with comorbidities such as hypertension1,8
Could a genetic component be complicating the management of your patient with sHTG?
portrait of sHTG patient model named Maria with quote: It's frustrating when medication doesn't work and the doctor isn't sure why
"It’s frustrating when medication doesn’t work and the doctor isn’t sure why."
Not a real patient; actor portrayal or generated model.

Maria, 53

Has sHTG

Not a real patient; actor portrayal or generated model.
  • Fasting TGs of 863 mg/dL during routine physical exam with primary care doctor
  • Repeat lipid panels show TG levels consistently ≥500 mg/dL
  • Has been on an omega-3 fatty acid and committed to lifestyle modifications, which slightly reduced TGs, but they were still ≥500 mg/dL
  • Started on a statin, and eventually a fibrate, but TGs remained ≥500 mg/dL
"It’s frustrating when medication doesn’t work and the doctor isn’t sure why."
  • Fasting TGs of 863 mg/dL during routine physical exam with primary care doctor
  • Repeat lipid panels show TG levels consistently ≥500 mg/dL
  • Has been on an omega-3 fatty acid and committed to lifestyle modifications, which slightly reduced TGs, but they were still ≥500 mg/dL
  • Started on a statin, and eventually a fibrate, but TGs remained ≥500 mg/dL
TG levels consistently ≥500 mg/dL (fasting)
TG levels ≥500 mg/dL are associated with an increased risk of AP and ASCVD1,3,4
TG level not at goal despite statin, fibrate, and omega-3 fatty acid therapy
Statins, fibrates, and omega-3 fatty acids do not reduce triglyceride levels sufficiently in all patients with sHTG6,7
Overweight with a BMI of 26 kg/m2
sHTG is commonly associated with comorbidities such as obesity1,8
Could Maria's limited response to the standard of care warrant a referral to a lipid specialist?

A1c=glycated hemoglobin; ACE inhibitor=angiotensin-converting enzyme inhibitor; AP=acute pancreatitis; ASCVD=atherosclerotic cardiovascular disease; BMI=body mass index; FCS=familial chylomicronemia syndrome; GLP-1=glucagon-like peptide-1; NAFCS=North American Familial Chylomicronemia Syndrome; TG=triglyceride.

References

References

  1. 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.

  2. Nawaz H, Koutroumpakis E, Easler J, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis. Am J Gastroenterol. 2015;110(10):1497-1503.

  3. Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ. 2007;176(8):1113-1120.

  4. Rashid N, Sharma PP, Scott RD, Lin KJ, Toth PP. Severe hypertriglyceridemia and factors associated with acute pancreatitis in an integrated health care system. J Clin Lipidol. 2016;10(4):880-890.

  5. Sanchez RJ, Ge W, Wei W, Ponda MP, Rosenson RS. The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis. Lipids Health Dis. 2021;20(1):72.

  6. Patel SB, Wyne KL, Afreen S, et al. American Association of Clinical Endocrinology clinical practice guideline on pharmacologic management of adults with dyslipidemia. Endocr Pract. 2025;31(2):236-262.

  7. 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.

  8. Hegele RA, Ahmad Z, Ashraf A, et al. Development and validation of clinical criteria to identify familial chylomicronemia syndrome (FCS) in North America. J Clin Lipidol. 2025;19(1)(online-only supplementary material):83-94.

  9. Rivera FB, Chin MNC, Pine PLS, et al. Glucagon-like peptide 1 receptor agonists modestly reduced low-density lipoprotein cholesterol and total cholesterol levels independent of weight reduction: a meta-analysis and meta-regression of placebo controlled randomized controlled trials. Curr Med Res Opin. 2025;41(1):185-197.

  10. Hegele RA, Ahmad Z, Ashraf A, et al. Development and validation of clinical criteria to identify familial chylomicronemia syndrome (FCS) in North America. J Clin Lipidol. 2025;19(1):83-94.

  11. Paquette M, Bernard S. The evolving story of multifactorial chylomicronemia syndrome. Front Cardiovasc Med. 2022;9:886266.

  12. Moulin P, Dufour R, Averna M, et al. Identification and diagnosis of patients with familial chylomicronaemia syndrome (FCS): expert panel recommendations and proposal of an "FCS score". Atherosclerosis. 2018;275:265-272.