Evaluation and Treatment of Hypertriglyceridemia

Publication Date: September 1, 2012
Last Updated: September 25, 2023


Diagnosis and Definitions

Severe and very severe hypertriglyceridemia increase the risk for pancreatitis, whereas mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease. Therefore, similar to the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guideline committee’s recommendations, the Endocrine Society recommends screening adults for hypertriglyceridemia as part of a lipid panel at least every 5 yr. (1, L)
Base the diagnosis of hypertriglyceridemia on fasting triglyceride levels and not on nonfasting triglyceride levels. (1, M)
AVOID the routine measurement of lipoprotein particle heterogeneity in patients with hypertriglyceridemia. (1, L)
Measurement of apolipoprotein B (apoB) or lipoprotein(a) [Lp(a)] levels can be of value, whereas measurement of other apolipoprotein levels has little clinical value. (2, L)

Causes of elevated triglycerides—primary and secondary

We recommend that individuals found to have any elevation of fasting triglycerides should be evaluated for secondary causes of hyperlipidemia including endocrine conditions and medications. Treatment should be focused on such secondary causes. (1, L)
We recommend that patients with primary hypertriglyceridemia be assessed for other cardiovascular risk factors, such as central obesity, hypertension, abnormalities of glucose metabolism, and liver dysfunction. (1, L)
We recommend that clinicians evaluate patients with primary hypertriglyceridemia for family history of dyslipidemia and cardiovascular disease to assess genetic causes and future cardiovascular risk. (1, L)

Management of hypertriglyceridemia

We recommend lifestyle therapy, including dietary counseling to achieve appropriate diet composition, physical activity, and a program to achieve weight reduction in overweight and obese individuals as the initial treatment of mild-to-moderate hypertriglyceridemia. (1, L)
For severe and very severe hypertriglyceridemia (>1000 mg/dl), we recommend combining reduction of dietary fat and simple carbohydrate intake with drug treatment to reduce the risk of pancreatitis. (1, H)
We recommend that the treatment goal for patients with moderate hypertriglyceridemia be a non-high-density lipoprotein (HDL) cholesterol level in agreement with NCEP ATP guidelines. (1, L)
We recommend that a fibrate be used as a first-line agent for reduction of triglycerides in patients at risk for triglyceride-induced pancreatitis. (1, M)
We suggest that three drug classes (fibrates, niacin, n-3 fatty acids) alone or in combination with statins be considered as treatment options in patients with moderate to severe triglyceride levels. (2, L)
We recommend that statins not be used as monotherapy for severe or very severe hypertriglyceridemia. However, statins may be useful for the treatment of moderate hypertriglyceridemia when indicated to modify cardiovascular risk. (1, L)

Recommendation Grading




Evaluation and Treatment of Hypertriglyceridemia

Authoring Organization

Publication Month/Year

September 1, 2012

Last Updated Month/Year

January 10, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings


Intended Users

Dietician nutritionist, diabetes educator, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D015228 - Hypertriglyceridemia


triglycerides, hypertriglyceridemia

Source Citation

Lars Berglund, John D. Brunzell, Anne C. Goldberg, Ira J. Goldberg, Frank Sacks, Mohammad Hassan Murad, Anton F. H. Stalenhoef, Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 9, 1 September 2012, Pages 2969–2989, https://doi.org/10.1210/jc.2011-3213