Hypertriglyceridaemia

Seek specialist advice:

• If TG >10
• TG 5–10 in a high cardiovascular risk patient not responding to statin treatment
• Suspected familial hyperlipidaemia
• Patients with significant hyperlipidaemia that is proving difficult to manage in primary care
• Refer urgently to secondary care those with TG >20 not caused by alcohol or poor glycaemic control

Triglycerides (TG) (mmol/L)

• Routinely measured as part of a full lipid profile to enable LDL calculation.
• TG testing in isolation is rarely indicated.
• Can be elevated on a non-fasting sample due to the presence of dietary TG, consider fasting sample.
• Very high TG levels e.g. >10mmol/L are associated with pancreatitis; increased morbidity and mortality independent of CVD risk.
• High TG are most commonly due to secondary causes e.g. poorly controlled diabetes mellitus, alcohol excess or medications.
• The relationship between TG and cardiovascular risk is unclear. Overall it is felt that raised TG still confer a small degree of additional risk.

Clinical assessment

• Examine for any skin changes suggestive of a primary hyperlipidaemia
• Check TFTs, fasting blood glucose (click here for more information on the diagnostic work-up for diabetes), renal function, liver function, MCV and GGT
• † Consider any relevant secondary causes e.g. review medications
• Further tests as appropriate e.g. pregnancy test, urinalysis to check for proteinuria

• Treat with a statinif at significant (based on usual criteria)

† Secondary causes of raised TG

• Alcohol excess
• Hypothyroidism
• Nephrotic syndrome/ renal disease
• Immunoglobulin excessDrugs (including thiazides, non-cardioselective beta blockers, oestrogens, tamoxifen, corticosteroids)
• Bulimia
• Pregnancy
• Obesity
• Insulin resistance
• Diabetes
• Metabolic syndrome

* Lifestyle advice

• Weight loss, if appropriate
• Reduce or abstain from alcohol
• Dietary modification:
  reduce total calorie intake by minimizing intake of fats and carbohydrate
  increase intake of fish, especially oily fish
• Smoking cessation (smoking independently increases TG levels)
• Increase physical activity

More information is available at the University of Edinburgh site  Lothian Hypertension and Lipid clinics