Clinical significance and management of hypertriglyceridemia

Despite significant advances in lowering LDL cholesterol, a substantial residual risk for atherosclerotic cardiovascular disease (ASCVD) persists, largely driven by triglyceride-rich lipoproteins (TRLs). This narrative review emphasizes the importance of hypertriglyceridemia in the development of atherosclerotic cardiovascular disease and acute pancreatitis and clarifies the diagnostic dilemmas and current therapeutic options. This narrative review explores the pathophysiology, diagnostic criteria, and epidemiological impact of hypertriglyceridemia. TRLs, including chylomicrons and VLDL, contribute to atherosclerosis through the accumulation of cholesterol-rich "remnant particles" and apolipoprotein B (Apo B) in the subendothelial space. Recent epidemiological data, including findings from the Copenhagen General Population Study and the SIMETAP-HTG study, confirm that mild-to-moderate hypertriglyceridemia (1.7-5.6 mmol/L) is prevalent in approximately 25% of the population and is strongly associated with increased risks of myocardial infarction, heart failure, and multiorgan diseases such as diabetes and MASLD. Conversely, severe hypertriglyceridemia (≥10 mmol/L) significantly elevates the risk of acute pancreatitis. Current guidelines emphasize measuring fasting triglycerides, though non-fasting levels are increasingly recognized for screening. The paper concludes that secondary causes must be ruled out upon diagnosis and highlights non-HDL cholesterol as a critical secondary therapeutic target for comprehensive cardiovascular risk management. The final part of the review is focused on novel therapeutic options and emerging therapies for increased TRL.