Management and Treatment
of High Triglycerides

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Management: An Overview of
Guidelines and Consensus Pathways

According to the American Heart Association, the American College of Cardiology, and multisociety guidelines, it is reasonable to reduce triglyceride levels in adults with TG ≥ 5.7 mmol/L (500 mg/dL) to reduce the risk of acute pancreatitis. Reducing TG levels is especially important in adults with TG >10.0 mmol/L (880 mg/dL) due to increased risk for acute pancreatitis at this level.23

For adults, current American College of Cardiology and American Association of Clinical Endocrinologists/ American College of Endocrinology Expert Consensus statements recommends lowering of fasting TG levels to < 1.7 mmol/L (150 mg/dL) to reduce ASCVD risk.2, 31

Initial Factors to Consider for Controlling TG Levels in Different Patient Subgroups

2021 American College of Cardiology
Expert Decision Pathway - modified from Virani et al.2

Initial Factors to Consider for Controlling TG Levels in Different Patient Subgroups Initial Factors to Consider for Controlling TG Levels in Different Patient Subgroups

Lifestyle and
Pharmacologic Treatments

The American College of Cardiology (ACC) and the National Lipid Association (NLA) have prepared screening questions to help clinicians assess the effects of lifestyle on triglycerides.2

  • How often do you consume sugar-sweetened beverages (soft drinks, fruit drinks, sweet tea, or sports/energy drinks)?
  • Do you consume sweets (pastries, desserts, or candy)? If so, how much and how often?
  • Do you drink alcoholic beverages (beer, wine, or spirits)? If so, how much and how often?
  • How often do you consume foods that are deep fried or high in saturated fats (ie, butter, coconut and other tropical oils, full-fat dairy products, or fatty red meat) as well as pizza?
  • Have you gained weight in the past year? If so, how much weight have you gained?
  • What do you do for physical activity? How often?

Average effects of lifestyle
interventions4,9

Lifestyle interventions

illustration
Intervention TG lowering
Alcohol abstinence Variable Can lower TGs by as much as 80% in people with elevated TG and excess alcohol intake
Weight loss Approximately 8 mg/dL (0.1 mmol/L) per kg weight loss
Dietary modification 0.18 mmol/L (15.7 mg/dL) reduction with plant-based diet enriched in protein and unsaturated fat
Aerobic exercise 10-20%
ω3-polyunsaturaed fatty acids (eg, fish, flaxseed) 10-50%

Pharmacologic interventions

illustration
Statins Dose-dependent; 22-45% reduction in people with baseline TG > 250mg/dL
Fibrates 30-50%
Niacin up to 30%

Nutrition
Management for
People with Extreme
HTG

For people with extreme HTG (monogenic or multifactorial), strict management of diet is critical to minimize the risk of pancreatitis and other complications.12

For more information, see reference 34.

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    SHOW REFERENCES

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