hypertriglyseridemia

Hypertriglyceridemia is a lipid disorder characterized by elevated triglyceride levels in the blood. In adults, fasting triglycerides above 150 mg/dL are considered abnormal, with higher levels associated with greater health risk. Severe hypertriglyceridemia (often defined as triglycerides above 500 mg/dL or 1000 mg/dL) increases the risk of acute pancreatitis and may signal an underlying metabolic or genetic syndrome.

Causes of hypertriglyceridemia are broadly divided into secondary and primary forms. Secondary causes include obesity, insulin resistance and type 2 diabetes, metabolic syndrome, hypothyroidism, chronic kidney or liver disease, nephrotic syndrome, excessive alcohol intake, and medications such as corticosteroids, estrogens, certain antiretrovirals, and diuretics. Primary genetic forms include familial hypertriglyceridemia, familial combined hyperlipidemia, and familial chylomicronemia syndrome, among others. The condition often coexists with other lipid abnormalities, such as low high-density lipoprotein cholesterol or elevated non-high-density lipoprotein cholesterol.

Clinical presentation varies; many individuals are asymptomatic. When triglycerides are very high, pancreatitis is a major concern. Other signs, such as eruptive xanthomas, can occur but are less common. The relationship between hypertriglyceridemia and cardiovascular disease is complex and influenced by coexisting lipid abnormalities and overall metabolic health.

Diagnosis relies on a fasting lipid panel and assessment for secondary causes. Evaluation may include screening for diabetes, thyroid disease, liver and kidney function, and lifestyle factors. Genetic testing is considered in select cases, particularly with suspected monogenic disorders.

Management emphasizes risk reduction and triglyceride lowering. Lifestyle interventions—weight loss, reduced intake of refined carbohydrates and alcohol, and regular physical activity—are first line. Pharmacologic therapy includes fibrates, high-dose omega-3 fatty acids, and statins to address overall cardiovascular risk. Niacin is used less frequently due to side effects. In select genetic forms, targeted therapies and specialized care may be indicated, and plasmapheresis can be considered in life-threatening pancreatitis.