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4.2.9. Management of Hypertriglyceridemia
COR LOE
Recommendations
1 B-NR
1. In adults with persistently elevated TG levels ≥150 mg/dL
(1.7 mmol/L), after evaluation and management of secondary
causes, lifestyle management (consuming a diet that consists
of low added sugars, as well as reduced alcohol and saturated
fat intake, routine exercise, and weight loss of 5%–10% of
body weight if overweight or obese) is recommended as a
first-line approach to reduce TG levels (Figure 2).
1 B-R
2. In adults with clinical ASCVD and LDL-C ≥55 mg/dL
(1.4 mmol/L) and non–HDL-C ≥85 mg/dL on maximally
tolerated statin with persistently elevated TG levels ≥150 to
999 mg/dL (1.7–11.3 mmol/L), intensification of LDL-C–
lowering therapy is recommended to reduce ASCVD risk.
1 B-R
3. In adults with FCS and fasting TG ≥1000 mg/dL
(11.3 mmol/L), olezarsen is recommended as an adjunct to
diet to lower TG levels and reduce the risk of pancreatitis.
2b B-R
4. In adults ≥50 years of age with clinical ASCVD or with
diabetes and ≥1 ASCVD risk factors, with persistently
elevated TG levels ≥150 to 499 mg/dL (1.7–5.6 mmol/L),
and LDL-C <100 mg/dL (2.6 mmol/L) on maximally
tolerated statin, the addition of IPE may be reasonable to
lower ASCVD risk. (See Figure 9 in Section 4.2.5, " Diabetes
in Adults Without Established ASCVD.")
1 A
5. In adults aged 40 to 75 years without a history of ASCVD or
diabetes who have persistently elevated TG levels ≥150 to 499
mg/dL (≥1.7–5.6 mmol/L), it is recommended to estimate
10-year ASCVD risk by the PREVENT-ASCVD equations to
guide the benefit-risk discussion regarding further optimization
of diet and lifestyle management as well as the potential
initiation of statin therapy to reduce ASCVD risk (Figure 11.)
2a B-NR
6. In adults with severe hypertriglyceridemia (persistently
elevated TG levels ≥500–999 mg/dL [5.7 mmol/L] and
especially with TG levels ≥1000 mg/dL (11.3 mmol/L)
despite dietary intervention, the use of fibric acid derivatives
or prescription omega-3 fatty acids is reasonable to lower TG
levels and reduce the risk of pancreatitis (Figure 11.)
2a B-NR
7. In adults with hypertriglyceridemia (TG ≥150 mg/dL),
measurement of non–HDL-C or apoB is preferred over
LDL-C to guide clinical decision- making.
