Triglycerides are a type of fat that circulates in the blood, serving as the body’s primary energy storage molecule. When a person consumes more calories than needed, those excess calories are converted into triglycerides and stored in fat cells. Having too many of these fats in the bloodstream, a condition called hypertriglyceridemia, is associated with an increased risk of cardiovascular events, such as heart attack and stroke.
The Role of Primary Care Physicians
The Primary Care Physician (PCP) is the starting point for most people managing high triglycerides, often identifying the issue through routine blood work called a lipid panel. PCPs are responsible for initial screening and the management of mild to moderate cases of hypertriglyceridemia, defined as levels between 150 and 499 milligrams per deciliter (mg/dL). The initial strategy focuses on assessing the patient’s lifestyle and proposing modifications.
The PCP will order follow-up tests to rule out or identify secondary causes contributing to the elevated levels. These underlying conditions can include uncontrolled diabetes, metabolic syndrome, or hypothyroidism. For many patients, the initial combination of dietary changes, increased physical activity, and weight loss can be highly effective in normalizing levels.
PCPs are equipped to initiate basic pharmacological treatments, such as a statin, especially if the patient also has high low-density lipoprotein (LDL) cholesterol or other cardiovascular risk factors. Statin therapy, while primarily for cholesterol, can modestly reduce triglyceride levels by 10 to 30 percent. If the triglyceride levels remain persistently elevated or fall into the very high range, the PCP will refer the patient to a specialist for more targeted care.
Specialists Who Treat Lipid Disorders
When high triglyceride levels are complex, severe, or resistant to initial management, a patient is referred to specialists focusing on lipid disorders.
Lipidologist
A Lipidologist is a physician with specialized expertise in diagnosing and treating all types of lipid abnormalities, including severe hypertriglyceridemia. They provide advanced, tailored treatment plans and are often consulted for genetic lipid disorders or cases that do not respond to standard medications.
Cardiologist
A Cardiologist focuses on the heart and blood vessels, managing high triglycerides when the goal is to reduce the risk of heart attack and stroke. They assess the patient’s comprehensive cardiovascular risk profile and determine if elevated triglycerides require aggressive management due to existing heart disease.
Endocrinologist
An Endocrinologist specializes in hormonal and metabolic conditions, which are often the root cause of high triglycerides. Conditions like uncontrolled Type 2 diabetes, metabolic syndrome, and hypothyroidism frequently lead to severe hypertriglyceridemia. This specialist focuses on managing the underlying metabolic disorder, which helps bring blood fat levels into a healthier range.
Deciding When to See a Specialist
A patient should expect a referral to a specialist when triglyceride levels are severely elevated, defined as 500 mg/dL or higher. At this level, the primary concern shifts to preventing acute pancreatitis, a sudden and severe inflammation of the pancreas. Immediate, aggressive intervention is necessary to lower these levels, often requiring specialized medication and dietary plans.
Referral is also warranted when high triglycerides are refractory, meaning they are resistant to the initial lifestyle changes and medications prescribed by the PCP. This resistance suggests a more complex underlying issue, such as a rare genetic lipid disorder, requiring a specialist’s diagnostic expertise. If the patient has other complex health conditions, comorbidities, like poorly controlled Type 2 diabetes or established cardiovascular disease, a specialist can better manage the intersecting risks. Complex medication regimens, including combination therapy or novel lipid-lowering agents, are best overseen by a specialist.
Medical Management and Treatment Approaches
Lifestyle Interventions
Treatment for high triglycerides begins with intensive lifestyle interventions, which are the foundation of management for all patients. This involves specific dietary adjustments, such as reducing the intake of refined carbohydrates, added sugars, and alcohol, as these contribute to elevated fat levels. Increasing consumption of omega-3 fatty acids, often through eating fatty fish, is also recommended. Achieving a weight loss of just 5 to 10 percent of body weight can lead to a substantial reduction in triglyceride levels. Patients often work with a Registered Dietitian or Nutritionist, who provides expert guidance on necessary dietary changes.
Pharmacological Treatments
When lifestyle changes are insufficient, pharmacological treatments become necessary. Fibrates, such as fenofibrate or gemfibrozil, are often a first-line drug for severe hypertriglyceridemia because they can lower triglyceride concentrations by 30 to 50 percent. High-dose prescription omega-3 fatty acids, specifically purified eicosapentaenoic acid (EPA), are also used and can reduce levels by up to 40 percent, particularly in patients who have elevated cardiovascular risk despite being on statins.
Statins are a common component of the treatment plan, offering a modest reduction in triglycerides while addressing overall cardiovascular risk. For patients with levels above 500 mg/dL, the immediate goal is to rapidly reduce the fat concentration below this threshold to mitigate the risk of pancreatitis. The specific combination of medications is determined by the patient’s lipid profile, overall health, and cardiovascular risk.