Cardiovascular risk, evaluation and management in patients with hypertriglyceridaemia: a Consensus Statement from the International Atherosclerosis Society

The prevalence of hypertriglyceridaemia is increasing globally owing to high rates of obesity and diabetes mellitus. Hypertriglyceridaemia is associated with an increased risk of cardiovascular disease, mediated through the cholesterol content of triglyceride-rich lipoprotein remnant particles rather than through triglycerides per se. Although plasma levels of triglycerides can be measured with a simple blood test, hypertriglyceridaemia remains underdiagnosed and undertreated. Hypertriglyceridaemia can result from various primary or secondary aetiologies, the identification and management of which is an important first step. Hypertriglyceridaemia can be managed with lifestyle measures, lipid-lowering therapy with statins in indicated patients to reduce cholesterol levels and, in refractory situations, with the addition of triglyceride-specific pharmacological therapies. Emerging therapies with considerable promise for the management of hypertriglyceridaemia include those targeting apolipoprotein C-III, angiopoietin-related protein 3 or fibroblast growth factor 21. However, so far, there is no evidence from randomized clinical trials that pharmacotherapies targeting triglycerides can reduce the occurrence of cardiovascular events, suggesting that elevated levels of triglycerides serve as a marker of atherosclerotic risk that should prompt optimization of modifiable cardiovascular risk factors. In this Consensus Statement, we provide clinical context and evidence for the evaluation, diagnosis and management of hypertriglyceridaemia.