Hypertriglyceridemia (HTG)

Triglycerides are a type of fat (lipid) found in your blood. They come from the foods you eat, and your body also makes them. When you consume more calories than your body needs, particularly from added sugars, refined carbohydrates, and alcohol, your body converts the excess into triglycerides and stores them for energy.

Fasting triglyceride levels:

Normal

• Less than 150 mg/dL
• Mild / Moderate HTG
• 150–499 mg/dL

Very high (severe HTG)

• 500 mg/dL or higher
• Very Severe HTG
• 1,000 mg/dL or higher

Pancreatitis and severe hypertriglyceridemia (sHTG): Mildly elevated triglycerides can increase your risk of heart disease over time. Very high levels (≥500 mg/dL) can cause acute pancreatitis, which is inflammation of the pancreas (a small organ behind your stomach). Pancreatitis will lead to a sudden swelling of the pancreas that can cause severe abdominal pain and may require hospitalization. The risk increases substantially when triglyceride levels reach 1,000 mg/dL or higher.

HTG often causes no visible symptoms, even when triglyceride levels are very high. Some people with very severe HTG (1,000 mg/dL) may develop small, yellowish skin bumps called eruptive xanthomas, which should go away when the fat levels drop. Occasionally, eye doctors might observe the discoloring of blood vessels under the eyes of sHTG patients.

When severe HTG leads to acute pancreatitis, symptoms may include:

• Severe upper abdominal pain
• Pain that spreads to the back
• Nausea and vomiting
• Fever

Seek prompt medical attention if you develop severe upper abdominal pain, particularly if it spreads to your back or occurs with nausea or vomiting. Acute pancreatitis can range from mild to severe and may require hospitalization and urgent treatment.

Hypertriglyceridemia (HTG) is diagnosed with a blood test that measures your triglyceride levels, usually after fasting.

Fasting triglyceride levels

• Normal: Less than 150 mg/dL
• Mild/moderate HTG: 150–499 mg/dL
• Severe HTG: 500 mg/dL or higher
• Very severe HTG: 1,000 mg/dL or higher

Finding the cause
Your healthcare provider may also test your blood sugar (glucose or A1C), thyroid function, and kidney and liver function. These tests can help identify conditions that may be contributing to high triglycerides.

Genetic testing
If your provider suspects a genetic cause, such as familial chylomicronemia syndrome (FCS), you may be referred to a blood fat specialist (lipidologist) and, in some cases, a genetic counselor for further evaluation and testing. Genetic testing is not always required for treatment, and a negative result does not necessarily rule out eligibility for treatments such as APOC3 inhibitors.

Managing HTG involves managing triglyceride levels, addressing underlying causes, and reducing the risk of future pancreatitis attacks.

Treatment during acute pancreatitis

Hospital treatment may include:

• IV fluids and temporary changes to eating: To support recovery and help the pancreas rest.
• Pain management: Medications may be needed to control severe abdominal pain.
• Insulin therapy: Insulin may be used in some patients, particularly those with high blood sugar or diabetes. It helps activate an enzyme called “lipoprotein lipase”, which helps the body break down and clear triglycerides from the blood.
• Nutrition support: Once you are able to eat, your healthcare team may recommend a low-fat diet to help lower triglyceride levels. A registered dietitian can help develop a plan tailored to your needs.
• Therapeutic plasma exchange (TPE), might be needed for extremely severe cases, to rapidly "wash" the fat out of the blood.

Long-term management

Your healthcare team may recommend:

• Following a low-fat diet: Some people with very high triglycerides may need a very low-fat diet. Under medical guidance, this may mean limiting fat to approximately 20–30 grams per day. Foods that may fit into a low-fat eating plan include egg whites, fish and lean proteins, beans and lentils, low-fat or fat-free dairy products, fruits, vegetables, and whole grains.

• Avoiding or limiting alcohol: Alcohol can significantly increase triglycerides and the risk of pancreatitis.

• Taking medications as prescribed: Your healthcare provider may prescribe medications such as fibrates or prescription omega-3 fatty acids to control your TG level. These medications help your body break down triglycerides and lower the amount of fat in your blood.  

• For people with very high triglycerides, injectable medications called APOC3 inhibitors may be an option. These medications work in the liver and help the body break down and remove triglycerides from the blood at the genetic level without harming or altering human DNA.

• Managing underlying conditions: Treating diabetes, obesity, thyroid disorders, and other contributing conditions can help improve triglyceride levels.

• Monitoring triglyceride levels: Regular blood tests help track progress and guide treatment decisions.

• Planning for pregnancy: Triglyceride levels can rise significantly during pregnancy. If you are pregnant or planning pregnancy, talk with your healthcare provider about appropriate monitoring and whether care from a high-risk obstetrics specialist is recommended.

Understanding the role of genetics and FCS

Familial chylomicronemia syndrome (FCS) is an inherited condition that can cause extremely high triglyceride levels (≥880 mg/dL). For people with FCS standard medications and lifestyle changes alone may not be enough to control triglyceride levels. If your healthcare provider suspects a genetic cause, you may be referred to a  blood fat specialist (lipidologist) and, in some cases, a genetic counselor for further evaluation and testing. Genetic testing is not always required for treatment, and a negative genetic test does not necessarily rule out eligibility for treatments such as APOC3 inhibitors.

Your care team

Managing HTG may involve a digestive system doctor (gastroenterologist), lipidologist,  a hormone and diabetes doctor (endocrinologist), primary care provider, registered dietitian, and other specialists as needed.  

Together, your care team can help identify the cause of high triglycerides, develop a personalized treatment plan, monitor your progress, and support your quality of life. The best care comes from providers who listen to your concerns, value your experiences, and work collaboratively with you and the rest of your care team.

With appropriate treatment, lifestyle changes, and regular follow-up, many people can lower their triglyceride levels and reduce their risk of future pancreatitis.

Resources

Learn more about FCS: https://pancreasfoundation.org/pancreas-disease/fcs/

Natina Lipid Association: https://www.lipid.org/

Living with FCS: https://www.livingwithfcs.org/