What Are High Triglycerides?

Table of Contents
View All
Table of Contents

Triglycerides are a type of fat that plays a key role in metabolism. When you eat, calories that aren't used are stored in fat cells as triglycerides where they can be called upon when energy is needed. They are then released into the bloodstream.

High triglycerides, or hypertriglyceridemia, is a medical condition in which more of these fats build up in the bloodstream than are burned off as energy. Causes may include obesity and type 2 diabetes, but other genetic and health factors may be involved as well. This may lead to serious illness if left untreated, but there are steps you can take to lower high triglycerides.

This article looks at symptoms common in people with high triglycerides, as well as how it is diagnosed and treated. It also explains lifestyle changes you can make to improve your triglyceride levels.

Older couple running in a park to lower high triglycerides
Betsie Van Der Meer / Getty Images

Symptoms

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. They include cardiovascular disease, atherosclerosis or "hardening of the arteries," and stroke.

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). Even levels at or above 443 mg/dL can increase the risk of a heart attack by more than threefold.

According to a 2013 study in Clinical Lipidology, the median age of onset of cardiovascular disease in adults with hypertriglyceridemia was 57 for women and 50 for men. The age of onset of pancreatitis was similar.

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. At this point, other organ systems may be affected. This may lead to:

  • 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
  • Neurological symptoms such as memory loss, depression, and dementia

Causes

Hypertriglyceridemia can be caused by many different things. These may broadly be described as lifestyle causes, genetic causes, medical conditions, and medications. They include:

  • Lifestyle: Obesity, a high-fat diet, a lack of physical activity, and excessive alcohol use
  • Genetic: Conditions that include familial hyperlipidemia, familial chylomicronemia, mixed hyperlipidemia, glycogen storage disease, and cholesteryl ester storage disease.
  • Medical conditions: Acute kidney failure, diabetes, hypothyroidism, pancreatitis, and lupus.
  • Medications: Beta-blockers, estrogen replacement therapy, estrogen-based oral contraceptives, thiazide diuretics, HIV protease inhibitors, 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 are high, such as diet or medications, and they may overlap. Treatment and lifestyle change are necessary, but they are not the same for everyone. Your healthcare provider will explain your lipid panel results and diagnosis.

Diagnosis

For most people, hypertriglyceridemia is diagnosed with a series of blood tests. This is known as a lipid panel. It will measure 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:

  • Normal: Less than 150 mg/dL
  • Borderline-high: Between 150 and 199 mg/dL
  • High: Between 200 and 499 mg/dL
  • Very high: 500 mg/dL or more
  • Severe: Between 1,000 to 1,999 mg/dL
  • Very severe: Over 2,000 mg/dL

If triglyceride levels are higher than 500 mg/dL, additional tests may be needed to see if there are genetic causes. 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 want to identify both the primary causes of hypertriglyceridemia, and sort out any secondary causes related to another health condition.

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 lifestyle changes and medication used together. 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. They include:

Low-fat diet: Changes in your diet may vary based on triglyceride levels. They usually involve restricting fats in your diet. This may mean replacing saturated and trans fats with polyunsaturated and monounsaturated fats, and eating fewer carbohydrates.

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.

Smoking cessation: If you smoke any amount, kicking the habit will 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) and Repatha (evolocumab).
  • 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

Drug treatment should be considered when "bad" LDL levels reach a certain threshold. Though triglyceride levels will be a part of this decision (especially in people with diabetes and familial hypertriglyceridemia), it is just one of two factors. The LDL values, paired with the risk of ASCVD, also are used to help decide whether treatment is needed or not.

According to the AHA/ACC guidelines, the treatment protocols are as follows:

  • For adults with clinically diagnosed ASCVD, start a statin drug at the maximally tolerated dose.
  • For adults with an LDL over 70 mg/dL and a moderate risk of ASCVD, start with a moderate-intensity statin.
  • For adults with an LDL over 70 mg/dL and diabetes, start with a moderate-intensity statin.
  • For adults with an LDL over 70 mg/dL and a very high risk of ASCVD, start with a high-dose statin with or without Zetia. A PCSK9 inhibitor can be added, as needed.
  • For adults with an LDL greater than 190 mg/dL (but no ASCVD risk assessment), a high-dose statin with Zetia may be appropriate. A PCSK9 inhibitor can be added, as needed.

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

Once you have a hypertriglyceridemia diagnosis, your healthcare provider will work with you on a treatment plan. There are quite a few drugs available to treat the condition, depending on the cause and your overall health history. You may need one, but high triglyceride levels are never treated with drugs alone. It is important for you to reduce your intake of fat and sugar, 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:

  • 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 proper nutrition.
  • Control all 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 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 your insurance plan.
  • Seek financial assistance: PCSK9 inhibitors are expensive. Don't assume that you can't afford them if you're uninsured or have high copay or deductible costs. There are copay assistance programs available for both Praluent and Repatha that may reduce your out-of-pocket costs.

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 needs to be treated, and will need to be 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 across 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, if necessary. Your healthcare provider can help you develop and stick with a plan.

A Word From Verywell

It can be frustrating to learn your triglyceride and other lipid levels are higher than is healthy. That's especially true because it means you'll have to make some permanent changes in your lifestyle whether you also need medication or not. But it's vital to never treat hypertriglyceridemia in isolation. By managing your blood sugar, blood pressure, weight, bone health, lung health, and chronic medical conditions, you will almost always improve your blood lipid profile.

Was this page helpful?
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Karanchi H, Wyne K. Hypertriglyceridemia. In: StatPearls. Updated February 17, 2019.

  2. 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

  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

  4. Sezgin O, Özdoğan O, Yaraş S, Üçbilek E, Altıntaş E. Evaluation of hypertriglyceridemia-induced acute pancreatitis: A single tertiary care unit experience from TurkeyTurk J Gastroenterol. 2019;30(3):271-7. doi:10.5152/tjg.2018.18292

  5. Chait A, Subramanian S. (2019) Hypertriglyceridemia: Pathophysiology, Role of Genetics, Consequences, and Treatment. Feingold KR, Anawalt B, Boyce A, et al. (eds). South Dartmouth, Massachusetts: MDText.com, Inc.

  6. 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

  7. 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

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

  9. American Heart Association. American Heart Association Recommendations for Physical Activity in Adults and Kids. Dallas, Texas: April 18, 2018.

Additional Reading