By Rosalyn Carson-DeWitt, MD 

 Medically reviewed by Yasmine S. Ali, MD, MSCI

High triglycerides, or hypertriglyceridemia, is a medical condition in which there is too much of a certain type of fat called triglycerides in the blood.

Triglycerides play a key role in metabolism, the process by which your body turns food and drink into energy. Calories that aren't used right away are stored in fat cells as triglycerides so they can later be called upon when energy is needed. High triglyceride levels occur when more of these fats build up in the bloodstream than are burned off.

Hypertriglyceridemia may lead to serious illness if left untreated. However, there are steps you can take to bring your levels back to a normal range.

This article looks at what causes high triglycerides and the symptoms common in people with this condition. It also delves into how it is diagnosed and treated with lifestyle changes and medication.

Betsie Van Der Meer / Getty Images

Symptoms and Complications

Hypertriglyceridemia usually doesn't cause symptoms until triglyceride levels become excessively high—typically between 1,000 milligrams per deciliter (mg/dL) and 2,000 mg/dL.

At this level, symptoms of pancreatitis (inflammation of the pancreas), including upper abdominal pain and nausea, may occur.

These persistently high levels are linked to other serious illnesses, too. These include cardiovascular disease, atherosclerosis or "hardening of the arteries," and stroke.¹

Symptoms of atherosclerotic cardiovascular disease (ASCVD) can develop at these levels. People may report having angina (chest pain), dyspnea (shortness of breath), and arrhythmia (irregular heartbeat).² Even levels at or above 443 mg/dL can increase the risk of a heart attack by more than threefold.³

Triglyceride levels also may be high with metabolic syndrome, a group of conditions that increases your risk of diabetes, stroke, and heart disease. Some factors that can lead to a diagnosis include a triglyceride level of 150 mg/dL or higher, high blood pressure, and high blood sugar.

Levels that are near or exceed 5,000 mg/dL typically are seen only in people with genetic disorders that can cause extreme elevations in triglycerides and cholesterol.⁴

At this point, other organ systems may be affected, potentially leading to:⁵

• Enlarged liver and spleen

• Small, painless nodules on the torso, buttocks, and thighs

• Small nodules on the elbows and knees

• A yellowish color on the palms

• Yellowish, raised spots around the eyelids

• Gray, white, or yellow deposits around the cornea of the eye

• Acute pancreatitis, with fever, vomiting, rapid heart rate, and abdominal pain

• Nervous system-related symptoms such as memory loss, depression, and dementia

Causes

Hypertriglyceridemia can be caused by many different things. In the U.S., this condition is common due to obesity, a diet that's high in fat and sugars, and diabetes. Other causes may include:

• Lifestyle: A lack of physical activity, as well as excessive alcohol use

• Genetic conditions: Conditions that include familial combined hyperlipidemia (a disorder that increases blood fats) as well as familial chylomicronemia (a genetic inability to break down fats), glycogen storage disease (sugars build up inside your cells), and cholesteryl ester storage disease (a buildup of fats)⁴

• Other medical conditions: Acute kidney failure, diabetes, hypothyroidism, pancreatitis, and lupus

• Medications: Beta-blockers, estrogen replacement therapy, estrogen-based birth control pills, thiazide diuretics, certain HIV drugs, isotretinoin, steroids, and tamoxifen

Recap

You may first hear that you have high triglyceride levels after routine tests of your lipid levels. That's because most symptoms don't appear until these levels are extremely high. There may be many reasons for why levels may be too high, such as diet or medications, and it's possible more than one may be at play.

Diagnosis

For most people, hypertriglyceridemia is diagnosed with a series of blood tests known as a lipid panel.

It measures triglycerides and the major forms of cholesterol, including total cholesterol, high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL).

Prior to having a lipid panel, you may be asked to fast for 12 to 14 hours. Lab results are usually back within one to two days.

The triglyceride test results are described within a standard range of values set by the Endocrine Society Task Force:⁶

If triglyceride levels are higher than 500 mg/dL, additional tests may be needed to see if there is a genetic cause. A physical exam may be done to check for skin and eye symptoms, as well as swelling of the liver or spleen.

In cases like these, a healthcare provider will identify the primary causes of hypertriglyceridemia. They'll also want to diagnose any other health conditions related to the high triglycerides.

These other conditions may include:

• Alcohol abuse

• Hormone replacement therapy

• Hypothyroidism (low thyroid levels)

• Kidney failure

• Pancreatitis

• Type 1 diabetes

• Type 2 diabetes

Treatment

Hypertriglyceridemia typically is treated with a combination of lifestyle changes and medication.

For borderline-high levels, drugs may not be needed right away, but a diet and exercise program to improve overall health will be essential.

Lifestyle

Treating hypertriglyceridemia usually starts with an adjustment of lifestyle factors including diet, activity, smoking habits, and alcohol consumption.

Diet

Changes in your diet may vary based on triglyceride levels. They usually involve limiting sugars and fats in your diet. This may mean replacing saturated and trans fats with polyunsaturated and monounsaturated fats and eating fewer carbohydrates.⁷

Exercise

This should involve a combination of moderate aerobic exercise and resistance training. A personal trainer can design a program tailored to your fitness level. They can help you safely and gradually increase the intensity and duration of workouts over the course of weeks and months.

The American Heart Association (AHA) recommends between 30 and 60 minutes of aerobic exercise most days of the week. Resistance training should be done for at least 20 to 30 minutes twice weekly.⁸

Always consult with your healthcare provider before starting a new routine.

Smoking Cessation

If you smoke any amount, kicking the habit can lower your risk of atherosclerosis and cardiovascular disease.

Decreased Alcohol Consumption

For some people, drinking can cause triglyceride levels to rise. Your healthcare provider can tell you if alcohol might be a factor for you and advise you to cut back (and by how much) or stop drinking altogether.

Medications

It is rare for a person's triglyceride levels to rise while all other lipids remain normal. That's why the decision to start medication usually is based on a review of the entire lipid profile.

To this end, the AHA in association with the American College of Cardiology (ACC) established guidelines for the appropriate treatment of hyperlipidemia (high blood lipids) as a whole. Among the medications used to reduce triglycerides and improve cholesterol levels are:

• Statin drugs, such as Crestor (rosuvastatin), Lipitor (atorvastatin), Pravachol (pravastatin), and Zocor (simvastatin)

• Zetia (ezetimibe), the first in a class of selective cholesterol-absorption inhibitors 

• PCSK9 inhibitors, a class of injectable biologic drugs consisting of Praluent (alirocumab), Repatha (evolocumab), and Leqvio (inclisiran)

• Fibrate acid derivatives, such as Atromid-S (clofibrate) and Lopid (gemfibrozil)

• Bile acid sequestrants, such as Questran (cholestyramine) and Welchol (colesevelam)

• Nicotinic acid, also known as niacin

Though triglyceride levels will be a part of this decision to start medication or not, that is just one factor that is weighed. LDL values and one's risk of ASCVD are also used to help make this call. The specific treatments needed will vary depending on the LDL results and the level of ASCVD risk.

Some people also may require immediate treatment for extremely high levels of triglycerides. This is often the case when these levels are linked to a genetic disorder, and the person has acute pancreatitis, or an enlarged liver or spleen. This treatment may include fibrate drugs and high-dose prescription omega-3 fatty acids.

Recap

There are quite a few drugs available to treat high triglyceride levels, depending on the cause and your overall health history. You may need one, but high triglyceride levels are never treated with drugs alone. It's important for you to limit fat and sugar intake, exercise regularly, reduce alcohol consumption, and stop smoking.

Coping

Hypertriglyceridemia is not a condition that can be "cured." Rather, it is one that must be managed for a lifetime to reduce the risk of heart disease and improve overall health and well-being.

To that end, it can help to both manage your expectations and tap into knowledge and resources that can make the road ahead easier.

Set Realistic Goals

Do not start an aggressive weight-loss program if you are inactive and 20 to 30 pounds overweight.

Work with your healthcare provider to achieve goals in manageable steps so that you can sustain your program over the long term.

Learn Good Nutrition

You need to remain healthy and have enough energy to fuel your day, even if you have diet restrictions.

Steer clear of fad diets, and work with a dietitian to create a sensible, balanced approach to eating that incorporates nutrient-rich foods.

Control Dietary Sugar

Extra calories from sugar are converted by the body into triglycerides. This includes fructose, the sugar in fruit. It's important to get your dietary fiber from fruit and other food sources, but don't go overboard.

Use fresh whole fruit to replace candy and other sweets, including fruit drinks made with high-fructose corn syrup.

Seek Support

It's hard to stick to diet and fitness programs without help from family and friends. Explain to them why you need to make lifestyle changes and how they can help.

Don't try to go it alone. If needed, ask your healthcare provider to speak with your loved ones.

Seek Treatment, If Needed

If you have a drinking problem or are unable to stop smoking, ask your practitioner about treatment options.

The Affordable Care Act mandates that certain alcohol addiction and smoking cessation aids be made available free of charge as an Essential Health Benefit (EHB) of insurance plans.

Seek Financial Assistance

Medications, especially PCSK9 inhibitors, can be expensive. Prescription assistance programs may help defray some of your out-of-pocket costs.

Manufacturers of Praluent, Repatha, and Leqvio all offer such programs for eligible patients.

Summary

What's most important to know about high levels of triglycerides⁠—which may arise from a number of possible causes⁠—is that they pose a serious health risk. This condition needs to be treated and controlled across a lifetime.

Fortunately, there are a number of drug options available. Which ones you'll need now, or perhaps later down the road, will depend on the results of lipid panel tests used to check your triglyceride and cholesterol levels over time.

In all cases, though, lifestyle changes will help to lower the numbers. They include shifting to a low-fat diet and getting enough exercise while avoiding tobacco and limiting alcohol. Your healthcare provider can help you develop and stick with a plan.

Sources

Karanchi H, Wyne K. Hypertriglyceridemia. In: StatPearls.

Talayero BG, Sacks FM. The Role of Triglycerides in Atherosclerosis. Curr Cardiol Rep. 2011 Dec;13(6):544-52. doi:10.1007/s11886-011-0220-3

Petersen SB, Langsted A, Nordesgaard BE. Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med. 2016;176(12):1834-42. doi:10.1001/jamainternmed.2016.6875

Chait A, Subramanian S. Hypertriglyceridemia: Pathophysiology, Role of Genetics, Consequences, and Treatment. Feingold KR, Anawalt B, Boyce A, et al. (eds). South Dartmouth, Massachusetts: MDText.com, Inc.

Chyzhyk V, Kozmic S, Brown AS, et al. Extreme hypertriglyceridemia: Genetic diversity, pancreatitis, pregnancy, and prevalence. J Clin Lipidol. 2019;13(1):89-99. doi:10.1016/j.jacl.2018.09.007

Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and treatment of hypertriglyceridemia: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Sep;97(9):2969-89. doi:10.1210/jc.2011-3213

O'Brien SJ, Omer E. Chronic pancreatitis and nutrition therapy. Nutr Clin Pract. 2019;34 Suppl 1:S13-S26. doi:10.1002/ncp.10379

American Heart Association. American Heart Association Recommendations for Physical Activity in Adults and Kids. Dallas, Texas.

Additional Reading

Grundy SM, Stone NJ, Bailey AL, et al. 2018 ACC/AHA/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology Foundation/American Heart Association task force on clinical practice guidelines. Circulation. 2019;2019:e1082-e1143. doi:10.1161/CIR.0000000000000625

Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2011;123:2292-333. doi:10.1161/CIR.0b013e3182160726

By Rosalyn Carson-DeWitt, MD
Rosalyn Carson-DeWitt, MD is a medical writer, editor, and consultant.