Primary prevention

Identification and management of modifiable secondary factors is key to reducing risk of HTG. Secondary causes of HTG include medical conditions, lifestyle factors, and drugs.[4][5][9]

  • Medical conditions: diabetes mellitus, metabolic syndrome, insulin resistance, obesity, chronic kidney disease, nephrotic syndrome, hypothyroidism, pregnancy (particularly in the third trimester when triglyceride elevation associated with pregnancy is peaking), myeloma, systemic lupus erythematosus, liver disease, HIV infection, Cushing syndrome, sarcoidosis

  • Lifestyle factors: excessive alcohol consumption; diet high in saturated fat, sugar, or high glycaemic index foods; sedentary lifestyle

  • Drugs: glucocorticoids, anabolic steroids, oral oestrogens, thiazide and loop diuretics, non-cardioselective beta-blockers, isotretinoin, bexarotene, propofol, bile acid sequestrants, cyclophosphamide, asparaginase, capecitabine, interferon, tacrolimus, sirolimus, ciclosporin, protease inhibitors, second-generation antipsychotic agents (e.g., clozapine, olanzapine).

Increased physical exercise and a diet low in saturated fat, sugar, or high glycaemic index foods may reduce risk directly and through reduction in risk of medical conditions such as obesity, metabolic syndrome, or insulin resistance.[13][49]​​ Excessive alcohol consumption (>1 and >2 units daily, respectively, for women and men) should be avoided.[35] The US Preventive Services Task Force recommends that adults at increased risk of cardiovascular disease are offered behavioural counselling interventions to promote a healthy diet and physical activity; those not at high risk may also be considered for behavioural counselling interventions.[50][51]

Drugs that raise triglycerides should be reviewed and metabolically neutral substitutes should be considered. Medical conditions associated with elevated triglyceride levels should be identified and managed appropriately.

Secondary prevention

Adherence to a lifestyle that improves weight management by reduced calories from saturated fats, coupled with regular physical activity, is the most important approach to prevent HTG and its complications, including atherosclerotic cardiovascular disease and acute pancreatitis.

The US Preventive Services Task Force (USPSTF) recommends that adults ages 40 to 75 years who have dyslipidaemia and an estimated 10-year cardiovascular disease risk of 10% or greater should be started on a statin for prevention of CVD. Those with 10-year risk of 7.5% to less than 10% may selectively be offered a statin.[84]

Use of this content is subject to our disclaimer