Table 1. Management protocol for raised serum triglycerides.

Abnormal level	Action
Serum TG level >5 mmol l−1 pre chemotherapy	• Refer directly to GP for investigation and/or management
Fasting serum TG level 5–10 mmol l−1 during chemotherapy	• Calculate CVD risk prediction using validated prediction charts (from Williams et al, 2004); if CVD risk >20% over next 10 years, start fenofibrate as given below, if cancer-related prognosis is sufficient to justify this (>3 months)
Serum TG level >10 mmol l−1 during chemotherapy	• Commence oral fenofibrate (267 mg) daily (unless any contraindications)  • Inform patient and GP of result and advice  • Repeat serum TG level after 1–2 months to ensure normalisation of TG level  • Discontinue fenofibrate 3 months after end of chemotherapy if TG improves to <2.1 mmol l−1 and CVD risk score is <20%  • Advise further repeat lipid profiling 3 months after discontinuation of fenofibrate
Grossly elevated TG level (>15 mmol l−1) at any time	• As per serum TG level >10 mmol l−1, but also refer directly to metabolic team for investigation

Abbreviations: CVD=cardiovascular disease; GP=general practitioner; TG=triglycerides.