The American Heart Association has defined the optimal upper limit for fasting triglycerides as 100 mg/dL, while elevated levels are still defined as 150 mg/dL or higher, according to a new scientific statement.
However, 100 mg/dL should not be targeted by medical therapy because studies have not shown the benefit of using drugs to reach this level, the statement concluded.
The statement includes a suggested algorithm for screening and managing elevated triglyceride levels, and advises initially using nonfasting levels for screening. The statement complements recent American Heart Association scientific statements on childhood and adolescent obesity and dietary sugar intake. While the statement is not intended to serve as a specific guideline, it will influence future evidence-based guidelines. The statement was published online April 18 in Circulation.
A nonfasting level of less than 200 mg/dL is commensurate with a normal (<150 mg/dL) or optimal (<100 mg/dL) fasting triglyceride level and requires no further testing, according to the statement. Nonfasting triglyceride levels are not used in the definition of metabolic syndrome and should not be used to calculate low-density lipoprotein cholesterol by the Friedewald formula.
Fasting samples can be categorized as borderline high (150 to 199 mg/dL), high (200 to 499 mg/dL), or very high (≥500 mg/dL). Treatment should focus on intensive therapeutic lifestyle change, which can reduce triglycerides by 50%. The statement notes that weight loss of 5% to 10% could lower triglycerides by 20%. A low carbohydrate diet that reduces sugars and fructose while increasing unsaturated fat intake may lower triglyceride levels another 10% to 20%. Eliminating trans fats, restricting saturated fats and increasing marine-based omega-3 fatty acids, in addition to aerobic activity, help triglyceride-lowering efforts.
Medication's role in triglyceride levels lacks evidence from clinical trials, according to the statement. First, clinicians should rule out medications such as hormone therapy and conditions such as diabetes as potential causes of high triglycerides. Women of reproductive age who develop hypertriglyceridemia while taking oral contraceptive therapy should consider contraceptive products that contain less estrogen, or other sforms of birth control. Postmenopausal women with hypertriglyceridemia who require postmenopausal hormone preparations may consider transdermal preparations that blunt the triglyceride increases seen in oral drugs.
Triglyceride-lowering medications to prevent pancreatitis in those with triglyceride levels above 500 mg/dL are a reasonable addition to intensive therapeutic lifestyle change, according to the statement. Those with a history of triglyceride-induced pancreatitis should keep triglyceride levels well controlled through lifestyle and drugs.