Raised triglycerides (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • North NHS Highland only
  • Primary and Secondary Care
  • Adults only

As triglycerides increase so does the risk of pancreatitis. Cohort studies indicate that acute pancreatitis may occur in 3% of those with triglyceride concentrations 10 to 20 mmol/L and 15% of those with levels > 20 mmol/L (doi:10.1093/eurheartj/ehz785).

If triglycerides 2 to 10 mmol/L:

  • This is most likely caused by diabetes, alcohol intake, elevated BMI, medications, liver disease or excessive oral intake prior to the test.
  • Aim to treat triglycerides via cause.
  • If ALT also raised: consider liver screen as per TAM liver guidance and need for assessment for metabolic-dysfunction associated steatotic liver disease (MASLD).
  • Treat cholesterol as per TAM lipid guidance.
  • Treating based on non-HDL cholesterol is particularly useful for these patients as it includes cholesterol in triglyceride rich particles e.g. VLDL and cholesterol rich particles e.g. LDL.
  • LDL cholesterol is not available when triglycerides > 4.5 mmol/L, as the Friedewald equation used to calculate LDL cholesterol is only valid at low triglyceride levels.

If triglycerides 10 to 20 mmol/L:

  • Assess patient for pancreatitis and hyperglycaemia, and consider alcohol intake.
  • Most raised triglycerides at this level are caused by uncontrolled diet, diabetes or alcohol intake.
  • Promptly aim to treat triglycerides via cause.
  • Not all blood results may be available from laboratory. High triglyceride levels, and the turbidity they cause, interfere with some of the methods used in the laboratory for analysis.
    • LDL cholesterol is not available when triglycerides > 4.5 mmol/L
    • HDL cholesterol is not available when triglycerides > 10.9 mmol/L.
  • Repeat lipid profile within 6-14 days, preferably on fasting sample if safe to do so. If the cause has been treated, and the triglycerides have responded, then all blood test results should now be available.
  • If no clear reversible cause or unable to remove cause: consider use of bezafibrate and referral to lipid clinic.
  • If ALT also raised: consider liver screen as per TAM liver guidance and need for assessment for metabolic-dysfunction associated steatotic liver disease (MASLD).
  • Lipid consultant available via Clinical Dialogue, if required, but note single handed consultant and reply only guaranteed within 15 days.

If triglycerides > 20 mmol/L:

  • Urgently assess patient for pancreatitis and hyperglycaemia, and consider alcohol intake. Also consider medications and liver disease. Aim to treat triglycerides via cause if possible.
  • Result will be phoned by laboratory if new finding.
  • Advise urgent lifestyle intervention: stop all alcohol (ensure safe to do so), no fat intake for 48 hours (removes dietary source, ensure safe to do so), and if hyperglycaemia, insulin infusion should be considered.
  • Discuss with acute medical or surgical team, if patient in primary care and admission required for management.
  • It may be that only limited laboratory test results are available due to triglycerides, and the turbidity they cause, interfering with laboratory analysis. Try using blood gas machine, as different methodology to laboratory. This is especially recommended for sodium as high triglycerides cause pseudohyponatraemia for the laboratory method but not the blood gas method.
  • Prompt management and reversal of cause will cause triglycerides to fall and full laboratory analysis will be possible. Given the heterogeneity of the types of lipoprotein seen in raised triglycerides, it is not possible for the laboratory to do anything to mitigate the effects of high triglycerides.
  • If no clear reversible cause or unable to remove cause: consider use of bezafibrate to prevent recurrence.
  • Lipid consultant available via Clinical Dialogue if required but note single handed consultant and reply only guaranteed within 15 days. Phone Duty Biochemist 01463 705931, available Monday to Friday 09:00 to 18:00, and they can advise if a more urgent reply may be possible.

Examples of medications that can lead to severe hypertriglyceridaemia

  • Oral oestrogen
  • Selective oestrogen receptor modulators including tamoxifen, raloxifene and clomiphene
  • Oral retinoids
  • Cyclophosphamide,
  • L-asparaginase and capecitabine
  • Protease inhibitors
  • Propofol
  • Interferon
  • Immunosuppressants, including sirolimus and ciclosporin

Abbreviations

  • ALT: Alanine Aminotransferase
  • BMI: Body Mass Index
  • HDL: High-Density Lipoprotein
  • LDL: Low-Density Lipoprotein
  • MASLD: Metabolic dysfunction-associated steatotic liver disease
  • non-HDL: Non-High-Density Lipoprotein
  • VLDL: Very Low-Density Lipoprotein

Editorial Information

Last reviewed: 28/08/2025

Next review date: 31/08/2028

Author(s): Blood Sciences.

Version: 2

Author email(s): nhsh.tam@nhs.scot.

Approved By: TAM Subgroup of the ADTC

Reviewer name(s): R. Clarke, Consultant Biochemist.

Document Id: TAM710