What is Hyper-triglyceridemia (HTG)?

Whether due to lifestyle factors or genetics, high triglycerides in the blood — known as hypertriglyceridemia — can increase your risk of cardiovascular conditions, obesity, diabetes and metabolic conditions, and high blood pressure.

Understanding the causes and risk factors for hypertriglyceridemia can help you take proactive, preventative measures to guard against the long-term effects of elevated triglyceride levels and get effective treatment if diagnosed.

In this article, we’ll explain what hypertriglyceridemia is, how it impacts your health, how to prevent high triglycerides, and how to treat HTG if you already have it.

What is HTG?

Hypertriglyceridemia occurs when the volume of triglycerides in your blood is elevated.

Research shows that more than 12 million people in the U.S. have triglyceride levels that exceed an optimal level of 150 milligrams per deciliter (mg/dL) as defined by the Centers for Disease Control and Prevention (CDC).

Although lifestyle factors and genetics play a role in regulating triglyceride levels, it’s important to note the aging process also tends to increase triglycerides in both men and women, meaning that controlling triglyceride levels gets increasingly important as you get older. HTG is common in our modern age and with current dietary norms. For many people, HTG is quite treatable.

What are triglycerides?

You’re likely familiar with cholesterol, but triglycerides are actually the most common type of fat in the body. In fact, triglycerides are an important storage vehicle for excess energy from your diet, and certain hormones trigger their release when your body needs this stored energy.

• Triglycerides essentially store unused calories and provide your body with energy.
• Cholesterol is necessary to build cells and hormones.

Your body builds triglycerides when you eat fatty acids, which are important energy forms that your body requires. These fatty acids are pulled from your food and created in the walls of the intestine, as well as in the liver from internal fat sources, when three fatty acids are linked to a single glycerol molecule (think of the name: tri + glyceride). Now called a chylomicron, this effective transportation vehicle can carry triglycerides throughout the body to where they’re needed: muscle fibers can use the energy immediately, or the triglycerides can be repackaged for longer term storage as a fatty deposit.

Unfortunately for most people these days, our diet leads to more excess energy storage than use, resulting in fat buildup in the form of triglycerides.

High triglycerides combined with high LDL cholesterol (considered the bad cholesterol) or low HDL cholesterol (the good kind) can lead to fatty buildups in — and hardening of — your artery walls. Called atherosclerosis, this increases your risk of heart attack and stroke.

What are normal triglyceride levels?

High triglycerides in the blood are a precursor to other chronic medical conditions, which is why hypertriglyceridemia should be evaluated regularly and caught early, before it leads to long-term issues.

Your blood triglycerides should be less than 150 mg/dL.

High triglycerides are diagnosed at 150-499 mg/dL.

Triglycerides over 500 mg/dL is considered severe hypertriglyceridemia and may require multiple pharmaceutical interventions to treat.

Is hypertriglyceridemia serious?

Hypertriglyceridemia can be a serious condition, especially because it so often goes undetected.

Much like high cholesterol, there are no obvious symptoms of hypertriglyceridemia itself. You’ll need a blood test — also called a triglycerides test or lipid panel — to determine your triglyceride levels.

High levels of triglycerides have been associated with an increased risk of the following medical conditions or complications:

• Cardiovascular diseases, such as coronary artery disease, stroke, and heart failure
• Acute pancreatitis (inflammation of the pancreas that develops in a short time period)
• Heart attack and stroke=

When should I get my triglycerides checked?

It’s a good idea to have triglyceride tests done as part of your routine checkups, particularly as you enter your late 30s and early 40s. The U.S. Department of Health and Human Services recommends lipid panels in the following populations:

• Children with a family history of heart disease, stroke, and high cholesterol should get tested as young as the age of two
• Men between 20 and 45 and women between 20 and 55 should be tested every five years
• Men 45 and older and women 55 and older should be tested every one to two years
• Anyone over 65 should be tested every year

People with comorbidities such as diabetes, hypertension, and obesity, as well as those with unhealthy eating habits or lifestyles, should also get tested regularly.

For an effective lipid panel, you may need to fast for twelve hours before you have your blood test to ensure the most accurate results.

What are the Warning Signs of HTG?

Much like high cholesterol, hypertriglyceridemia often has no outward symptoms.

If you suspect that you may be at risk for developing hypertriglyceridemia, don’t wait for warning signs to appear. A lipid profile can help with early detection, and by the time symptoms appear, you’ve likely progressed into a more challenging treatment landscape.

Here are some symptoms those with high levels of triglycerides may experience:

Xanthomas

These are small yellow-red bumps that develop due to fat buildup beneath the skin. They can occur anywhere on the body, but typically appear near the eyelids, knees, feet, hands, and elbows.

Abdominal pain or discomfort

This may be a sign of acute pancreatitis, as upper abdomen pain is a common symptom. Nausea, fever, and tenderness around the abdomen may also occur.

Lipemia retinalis or hyperlipidemia

If your triglyceride levels exceed 1000 mg/dL — which is extremely high and generally genetic in nature — the eyes can be affected. This causes a creamy white discoloration of the retinal vessels and impaired visual acuity.

What are the Causes of HTG?

A number of factors can contribute to hypertriglyceridemia. Some can be controlled, while others are unavoidable. The good news is that no matter what’s causing your hypertriglyceridemia, there are treatment options available and ways to mitigate its effects.

Here are some risk factors and causes of hypertriglyceridemia.

Lifestyle factors

Many aspects of your lifestyle may be contributing to high triglyceride levels. Knowing what these factors are and how they contribute to hypertriglyceridemia can help you make necessary changes to lower triglyceride levels and avoid long-term complications.

Poor dietary habits

A high-calorie diet comprising lots of sugars, trans fats, and carbohydrates can increase your triglyceride levels. Be mindful of hidden fats and sugars that are found in juices, milk alternatives (especially coconut milk), and ‘many so-called “health” bars.

Foods that keep you fuller for longer and prevent you from overeating, such as whole grains, proteins, and fiber-rich fruit and vegetables are a great alternative to “fast energy” chips and otherwise.

Stress

Stress can affect your triglyceride levels as it triggers release of the hormone cortisol. When the body releases cortisol, blood glucose levels rise, which in turn prompts your body to release triglycerides into the blood.

Inactivity and a sedentary lifestyle

You might have heard the saying, "Sitting is the new smoking." It’s not untrue. The dangers of sitting for long periods of time are well-documented, and among the negative effects are increased triglyceride levels. We can see evidence of this when we look at studies that prove triglyceride levels decrease with exercise.

If you’re consuming calories but not using them due to inactivity, fat is stored in the form of triglycerides.

Medications that can cause hypertriglyceridemia

All medications have potential side effects, and some can even raise your triglyceride levels even if you live a healthy, active lifestyle. Before starting any medication, you should speak to your doctor about side effects and how to mitigate them. Some medications that can increase your triglyceride level include:

• Blood pressure medications
• Oral estrogen
• Medications used to treat HIV (antiretrovirals)
• Corticosteroids
• Chemotherapy and other breast cancer treatments like Tamoxifen (TAM)
• Antipsychotics used to treat conditions like autism, bipolar disorder, and ADHD

Genetic causes of hypertriglyceridemia

Familial hypertriglyceridemia occurs when elevated triglyceride levels run in the family and are caused by how your body processes fat. One in 500 people in the U.S. is genetically predisposed to developing this condition.

Medical conditions that cause hypertriglyceridemia

Just as hypertriglyceridemia can cause certain health conditions, other medical conditions can also raise your triglyceride levels, including:

• Kidney and liver disease
• Diabetes
• Obesity or excess weight
• Thyroid disease

What's the Best Treatment for High Triglycerides?

Pharmaceutical treatments for hypertriglyceridemia exist, but depending how severe your situation is, you may not need drug interventions.

Here are the top things you can do to lower elevated triglycerides:

Lifestyle changes for HTG

One lasting solution to lowering your triglycerides is making serious lifestyle changes.

• Decrease your caloric intake: This can be done by consuming less sugar, refined carbohydrates, and processed foods — especially meats that are high in saturated fat.
• Limit or abstain from alcohol: Even small quantities of alcohol can contribute to elevated triglycerides. Alcohol can also boost cholesterol levels and cause fatty liver disease, too.
• Quit smoking: Research has shown that smokers have higher triglyceride levels than nonsmokers. The nicotine contained in cigarette smoke affects your blood’s lipid profile.
• Get active: As our lives become more sedentary, scheduling time to exercise becomes more important.

Medications for HTG

If your triglyceride levels are very high, your doctor may recommend medication.

• Fibrates: These medications can treat high lipid levels and include fenofibrate (Tricor®, Triglide®) and gemfibrozil (Lopid®).
• Statins: Also called HMG-CoA reductase inhibitors, statins are effective at lowering cholesterol and treating hypertriglyceridemia to decrease the chance of cardiac events. Examples include atorvastatin (Lipitor®), lovastatin (Altoprev®), and simvastatin (Zocor®).
• Nicotinic acid: Also called niacin, nicotinic acid increases good cholesterol and decreases triglyceride levels. Brand names include Niacor® and Niaspan®.
• High-dose omega-3s: These prescription-strength supplements are very effective for treating severe cases of hypertriglyceridemia. Some examples include Lovaza®, Epanova®, and Vascepa®.

Surgery for HTG

Bariatric surgery — also known as gastric surgery or weight loss surgery — involves making changes to the digestive system for health or cosmetic reasons.

If neither lifestyle changes nor medications have been sufficient to lower your triglycerides into a healthy range, your physician may recommend bariatric surgery. One study conducted over a period of twelve months showed that bariatric surgery significantly decreased triglycerides and increased good cholesterol, in addition to weight loss.

Who is Most at Risk of Developing HTG?

People who have a family history of hypertriglyceridemia are naturally more likely to develop the condition, but lifestyle choices are the deciding factor for the average American.

Individuals who live sedentary lifestyles and consume lots of processed foods high in sugar and fat are more likely to have raised triglyceride levels and develop hypertriglyceridemia; however, routine blood tests can detect elevated triglycerides early, giving you the opportunity to make a change before you develop complications such as cardiovascular disease or acute pancreatitis.

If you’ve been postponing getting your triglyceride levels tested, LifeMD can help. Affiliated and board-certified doctors and nurse practitioners can provide lab referrals through an online consultation. Based on your results, we’ll create a treatment plan and recommend medications, when appropriate — with unlimited followup and ongoing care done virtually.

Learn more about hyperglyceridemia and how to treat it by scheduling a LifeMD virtual visit today.