Insulin resistance, visceral adiposity, and increased fatty acid production Metabolic syndrome (increased waist circumference reduced high-density lipoprotein cholesterol levels and elevated triglyceride levels, glucose levels, and blood pressure) Patients randomized to icosapent, 4 g daily, had lower cardiovascular mortality (number needed to treat = 111 to prevent one cardiovascular death over five years) one large randomized controlled trial Hypertriglyceridemia is a risk-enhancing factor for CVD consensus and expert opinionĬonsider icosapent (Vascepa) for patients with elevated triglyceride levels (150 to 499 mg per dL) and established CVD who are taking statins. Risk increases with triglyceride levels of 1,000 mg per dL (11.30 mmol per L) or higher consensus, standard practice, and expert opinionĬonsider statins in patients with triglyceride levels between 150 and 499 mg per dL (1.69 to 5.64 mmol per L) and borderline or intermediate cardiovascular risk. Prescribe fibrates and omega-3 fatty acids for patients with triglyceride levels of 500 mg per dL or higher to reduce the risk of pancreatitis. Simple carbohydrates, including fructose, can increase fatty acid production in the liver consensus and disease-oriented evidence Weight loss and reduction of visceral adiposity through nutrition and an exercise program consensus and disease-oriented evidenceĪdvise a lower-carbohydrate and higher-fat or higher-protein diet for those with triglyceride levels lower than 500 mg per dL (5.65 mmol per L). For patients with acute pancreatitis associated with hypertriglyceridemia, insulin infusion and plasmapheresis should be considered if triglyceride levels remain at 1,000 mg per dL or higher despite conservative management of acute pancreatitis.Įncourage weight loss of 5% or more to lower triglyceride levels and improve risk factors for CVD. Fibrates, omega-3 fatty acids, or niacin should be considered for patients with severely elevated triglyceride levels to reduce the risk of pancreatitis, although this has not been studied in clinical trials. For patients at high risk who continue to have high triglyceride levels despite statin use, high-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality (number needed to treat = 111 to prevent one cardiovascular death over five years). Statins can be considered for patients with high triglyceride levels who have borderline (5% to 7.4%) or intermediate (7.5% to 19.9%) risk. Calculating a patient's 10-year risk of atherosclerotic cardiovascular disease is pertinent to determine the role of medications. Moderate- to high-intensity physical activity can lower triglyceride levels, as well as improve body composition and exercise capacity. Lowering carbohydrate intake (especially refined carbohydrates) and increasing fat (especially omega-3 fatty acids) and protein intake can lower triglyceride levels. Management of high triglyceride levels (150 to 499 mg per dL) starts with dietary changes and physical activity to lower cardiovascular risk. Less common risk factors include excessive alcohol use, physical inactivity, being overweight, use of certain medications, and genetic disorders. Common risk factors for hypertriglyceridemia include obesity, metabolic syndrome, and type 2 diabetes mellitus. Severely elevated triglyceride levels (500 mg per dL or higher) increase the risk of pancreatitis. Hypertriglyceridemia, defined as fasting serum triglyceride levels of 150 mg per dL or higher, is associated with increased risk of cardiovascular disease.
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