Table 3.

Treatment strategies for hypertriglyceridaemia by triglyceride concentration

	Moderately high (2–9·9 mmol/L)	High (≥10 mmol/L)
Treatment priority	Prevent cardiovascular disease	Prevent acute pancreatitis
Primary therapeutic goal	Achieve LDL cholesterol target	Reduce triglyceride concentrations
Secondary therapeutic goals	Achieve non-HDL cholesterol target, which is 0·8 mmol/L higher than LDL cholesterol goal, or APOB concentration <0·8 g/L; rule out and treat secondary factors	Goals: achieve LDL cholesterol and non-HDL cholesterol goals once pancreatitis risk is decreased, as described above; rule out and treat secondary factors
Non-pharmacological therapeutic strategies	Reduce bodyweight, reduce alcohol intake, reduce simple sugar intake, increase aerobic activity, reduce total carbohydrate intake, replace trans and saturated fats with monounsaturated fats, increase dietary omega-3 fatty acids	Eliminate oral intake during acute pancreatitis with intravenous rehydration, then slowly re-introduce foods with small frequent meals, then longer-term strict fat-reduced diet (<20% of calories as fat), reduce bodyweight, reduce alcohol intake, reduce simple sugar intake, reduce total carbohydrate intake, replace trans and saturated fats with monounsaturated fats; increase dietary omega-3 fatty acids; increase aerobic activity
Pharmacological therapeutic strategies	Statins if necessary to control LDL cholesterol; if LDL cholesterol is close to goal, titrate statin dose to achieve both LDL and non-HDL cholesterol targets; if LDL cholesterol is at goal, but non-HDL cholesterol is still high, titrate statin dose or add fibrate, nicotinic acid, or omega-3 fatty acids	Consider fibrate, nicotinic acid, and omega-3 fatty acids