Step 9: Triglycerides

Triglycerides are naturally produced and stored in the body as fat. Most fats in foods are in the form of triglycerides. Elevated triglycerides have been shown to be an independent risk factor for CHD. High levels are also associated with obesity, diabetes, and high blood pressure.

ATP III Classification of Serum Triglycerides (mg/dL)
<150	Normal
150-199	Borderline high
200-499	High
>500	Very high

 

Treatment of Elevated Triglycerides
Triglyceride Level	Recommended Treatment
>150 mg/dL	Primary aim of therapy is to reach LDL goal. Intensify weight management. Increase physical activity. If triglycerides are 200 mg/dL after LDL goal is reached, set secondary goal for non-HDL cholesterol (total - HDL) 30 mg/dL higher than LDL goal.
200-499 mg/dL after LDL goal is reached	Intensify therapy with LDL-lowering drug, or Add nicotinic acid or fibrate to further lower VLDL
>500 mg/dL	very low-fat diet (<15% of calories from fat) weight management and physical activity fibrate or nicotinic acid when triglycerides <500 mg/dL, turn to LDL-lowering therapy.

Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals
for Three Risk Categories

Risk Category	LDL Goal (mg/dL)	Non-HDL Goal (mg/dL)
CHD and CHD Risk Equivalent (10-year risk for CHD >20%)	<100	<130
Multiple (2+) Risk Factors and 10-year risk 20%	<130	<160
0-1 Risk Factor	<160	<190

Treatment of low HDL cholesterol (<40 mg/dL)

• First reach LDL goal, then:
  
  • Intensify weight management and increase physical activity.
    
  • If triglycerides 200-499 mg/dL, achieve non-HDL goal.
    
  • If triglycerides <200 mg/dL (isolated low HDL) in CHD or CHD equivalent,
    consider nicotinic acid or fibrate.