Understanding
Very High
Triglycerides
For more information, visit
CardioSmart.org/VHTG
Understanding Very High Triglycerides
Keeping track of your cholesterol is a very good idea.
That’s also true for your blood pressure, blood sugar
levels, and waistline. You’ve probably heard about LDL
(“bad”) cholesterol and HDL (“good”) cholesterol. But
are you aware of the importance of your triglyceride
levels to your overall health? Triglycerides are one of the
four numbers you see on the standard blood test your
doctor gives you to check for cholesterol in your
bloodstream. When that triglyceride number is very
high, it can translate into real trouble for your heart and
lead to other health issues, as well.
Blood
Vessel
Blood Cell
Fat Cells
Triglycerides are a type
of fat that’s used as an
energy source for your
body. Too much of this
type of fat can clog
your arteries and
increase your risk for
heart attack or stroke.
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What are triglycerides?
Triglycerides are one type of fat (lipid) found in
your bloodstream. Your liver makes triglycerides,
and you also get them through many of the
foods you eat. In fact, your body converts any
extra calories after you eat right away into
triglycerides. Your fat cells store these fatty
substances. They are later released and circulate
the bloodstream to be used as energy by cells.
But as with LDL cholesterol, too much can be
harmful. Most dietary fats are triglycerides.
What are very high
triglycerides?
Having very high triglycerides (VHTG) means
that you have too much of this type of fat in
your blood. Your doctor may call this condition
severe hypertriglyceridemia.
This condition is detected through a simple
blood test called a lipid panel or lipid profile.
This test measures your:
• Overall cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides
You will likely be asked to get your blood taken
after fasting—when you haven’t had any food
or drink (except water) for at least eight hours.
That’s because the food you recently ate can
change your triglyceride level. Because so many
of your triglycerides come from the food you
eat, triglycerides are usually lowest after fasting
and highest after eating. So eating a heavy
meal can actually cause a spike in the amount
of triglycerides in the blood.
Like other types of cholesterol, triglycerides are
measured in milligrams per deciliter (mg/dL) of
blood.
Understanding Very High Triglycerides
There are four categories of triglyceride levels, according
to the American Heart Association. Someone is diagnosed
with very high triglycerides when the amount of
triglycerides found in the blood is 500 mg/dL or more;
under 150 mg/dL is considered normal.
Classification
Triglyceride Level (mg/dL)
Healthy
Less than 150 mg/dL
Borderline high
150 to 199 mg/dL
High
200 to 499 mg/dL
Very high
500 mg/dL or higher
What causes VHTG?
A number of factors can raise triglycerides, or cause very
high triglycerides. For example, it tends to be more
common in people with:
• Low thyroid levels (hypothyroid)
• Poorly controlled diabetes
• Kidney disease
• A genetic predisposition where the body
produces an excess amount of triglycerides
Other things that can raise triglyceride levels include:
• Certain medicines, including some birth control
pills, beta blockers, antipsychotics, and
corticosteroids
• A diet that is high in carbohydrates, or processed
or sugary foods
• Alcohol
• Not exercising
Are certain people more likely to
develop it?
Yes. As mentioned, some people have a genetic
deficiency or family history that makes them more prone
to very high triglycerides. The condition is also more
common in:
• People who are very overweight or obese
• Women, especially those who are pregnant, are
taking estrogen or hormone replacement therapy,
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or have polycystic ovary syndrome
• People who develop heart disease before age 50
• Mexican-American men
• Indian Americans
Being
Overweight
Age
Being
Inactive
Family
History
Poor
Diet
Are there signs and symptoms?
There usually aren’t any symptoms. However, people with
very high triglycerides can develop coronary disease at
an early age. Because there aren’t any overt symptoms,
routine blood testing to check your blood cholesterol
levels may be the best idea.
Why is VHTG dangerous?
Having very high triglycerides, no matter the cause, has
been linked to a higher chance of developing heart
disease and having a heart attack or stroke. While
research is still underway to find the exact relationship
between triglycerides and cardiovascular disease, we
know that very high triglyceride levels tend to cluster
with other risk factors, including being obese, high blood
pressure, and high cholesterol.
Research shows that very high triglycerides often occur
along with:
• Lower levels of “good” or HDL cholesterol, which
help clear cholesterol from the bloodstream
• Smaller particles of the “bad” cholesterol, which
can speed up atherosclerosis
Understanding Very High Triglycerides
• Changes to the body’s ability to break down
blood clots, which can increase the risk of stroke
• Metabolic syndrome
Taken together, these factors can set the stage for
serious cardiovascular problems.
There’s another potential problem. Extremely high levels
of triglycerides can also lead to pancreatitis, a very
serious condition in which the pancreas becomes
inflamed. Pancreatitis can cause significant pain and
usually results in hospitalization.
What is the usual treatment for
VHTG?
Research into whether lowering triglycerides can
measurably reduce the risk of heart disease or events is
still ongoing. Still, most experts say it’s best to keep
them within the normal range.
The goal of any treatment program is to:
1. Lower the amount of triglycerides in the blood
2. Control conditions that can raise triglyceride
levels (for example, obesity, diabetes,
hypothyroidism, kidney disease)
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Adopt a
healthy diet
Increase
physical activity
Lose weight
Taking prescription
medication may be required in
some patients for whom lifestyle
changes are not enough. Current
standards of care include statins,
fibrates, omega-3s and niacin
The best way to lower triglycerides is by making healthy
lifestyle choices. Just doing this can cut triglyceride
levels by half! That means you have some control over
reducing triglycerides.
Talk with your doctor about making healthier lifestyle
choices by taking these 4 steps:
1.Be more active—regular exercise can
lower triglycerides and raise good
cholesterol.
2.Improve your diet—that means trying
to:
■■ Cut out excess calories by limiting unhealthy
fats; dietary fat should only make up 25-35
percent of your total diet
■■ Eat fiber-rich carbohydrates such as vegetables
Understanding Very High Triglycerides
and whole grains, and limit simple carbohydrates
(white breads, pasta, potatoes)
■■ Limit alcohol, which can cause triglycerides to
spike in some people
■■ Eat foods rich in omega-3 fatty acids, available
in certain fish (salmon, tuna, lake trout, and
sardines), fish oil or flaxseed oil
■■ Avoid refined sugars
3.Lose weight and stay at a healthy body
weight—losing just 5-10 percent of your
weight can lower triglycerides.
4.Don’t smoke.
Lifestyle modifications seem to work well and, in some
cases, are as effective as taking medicine for lowering
triglycerides. Taking the above steps will help you
improve your overall health, too.
In some cases, your doctor may also prescribe
medications to lower your triglycerides. These might
include:
• Omega-3 fatty acids: Prescription forms of highdose omega-3 fatty acids (which are naturally found
in fish) can lower triglycerides, but researchers
don’t know exactly how yet. There are several
FDA-approved omega-3 fatty acid formulations for
VHTG; most include both EPA and DHA as active
ingredients. These tend to be well tolerated and
have been shown to reduce triglycerides by as much
as 50 percent.
• Fibrates: These medications work by impairing the
liver’s ability to release triglycerides.
• Niacin or vitamin B3: These work by reducing the
activity of a chemical needed for the body to
produce triglycerides.
• Statins: These are commonly used to lower LDL
cholesterol and may also lower triglycerides.
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As always, when taking
medications:
• Take them exactly as directed.
• Let your health care team know about all of the
other medicines you take.
• Report any side effects or concerns.
Medication
Important Considerations/
Side Effects
Omega-3
fatty acids
Only FDA-approved, prescription strength
omega-3 fatty acids should be used to
treat VHTG. While there are dietary
supplements (commonly referred to as
“off-the-shelf”), these are not the same.
People who have an allergy to fish or
shellfish should not take omega-3 fatty
acids. If you take the EPA and DHA
combination, you may need to get your
LDL cholesterol checked because DHA
seems to raise this in some people.
Swallow the liquid gel capsule whole and
do not take it with a hot beverage.
Tell your doctor if you notice any
bruising.
Niacin
Immediate-release formulations of this
drug that work quickly in the body can
sometimes result in flushing, itching,
stomach upsets, and raised blood sugar.
Fibrates
Dosages need to be adjusted for people
with kidney problems.
You should not take fibrates if you have
liver and/or gallbladder disease.
Taking statins and fibrates at the same
time can make serious muscle problems
more likely. This can lead to kidney
failure.
Statins
Minimal, if any, positive effect on
triglycerides, as research findings are
mixed.
Tell your doctor if you also take fibrates.
*This table does not address all concerns or special
considerations. Talk with your doctor about the pros and cons
of all medications.
Understanding Very High Triglycerides
There are many new treatments for very high triglycerides
being investigated, as well. As always, talk with your
doctor about the right approach for you.
Questions to ask
It’s always a good idea to be prepared to ask questions
about any condition you have. The more you know, the
more you can take proactive steps to take care of
yourself. On the next page are a few questions to help
get you started.
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Questions you might ask include:
•How are triglycerides different from
cholesterol?
•What is my triglyceride level?
•How often should this and my other cholesterol
levels be checked?
•Why do you think my triglyceride level is so
high?
•How can high triglycerides affect my heart
health?
•What is the best thing I can do to lower
triglycerides?
•What changes can I make to my diet that will
help?
•Do sugars cause high triglycerides?
•How can I better control other risk factors for
heart disease?
•How is the prescription form of omega-3 fatty
acids different from what I can get in the
grocery store or pharmacy?
Helpful resources
To learn more about triglycerides, visit
CardioSmart.org/VHTG
You can also find resources at:
National Heart, Lung, and Blood Institute
nhlbi.nih.gov
For more information, visit
CardioSmart.org/VHTG
Information provided for educational purposes only. Please consult your health care
provider regarding your specific health needs.
Dissemination of this brochure was made possible by a grant from
Amarin Pharma, Inc. Amarin was not involved in the development of this material
and in no way influenced it contents.
©2016, American College of Cardiology