Understanding Severe Hypertriglyceridemia (sHTG)

Triglycerides are a type of fat found in your blood. Your body gets these fats from the foods you eat. Your body also makes them in the liver. These fats provide energy for your cells.¹

However, having too much fat in the blood can lead to health problems. When these levels become very high, doctors call the condition severe hypertriglyceridemia (sHTG).¹

What is sHTG?

Doctors measure triglycerides using a blood test called a lipid panel. This test also measures your cholesterol. Triglyceride levels are measured in milligrams per deciliter (mg/dL). A normal level is less than 150 mg/dL. Severe hypertriglyceridemia occurs when levels are 500 mg/dL or higher. Some people have levels that reach 1000 mg/dL or more.¹

High levels of these fats can cause the blood to become thick. This increases the risk of cardiovascular disease. It also puts a lot of stress on your organs.^1,2

The biggest risk of very high triglycerides is acute pancreatitis. This is a sudden and painful swelling of the pancreas. The pancreas is an organ that helps you digest food and manage blood sugar. Pancreatitis is a medical emergency that requires a stay in the hospital.^1,2

What causes sHTG?

Many factors can cause triglyceride levels to rise. Doctors group these causes into 2 categories. These are primary causes and secondary causes.^1,2

Primary causes are related to your genetics. Some people inherit genes that make it hard for the body to break down fats. Their bodies may also produce too many triglycerides. These people often have high levels even if they live a healthy lifestyle and eat a healthy diet.¹

Secondary causes are related to lifestyle choices or other health conditions. Some of these include:¹

• Living with obesity or being overweight
• Having poorly managed type 2 diabetes
• Having liver disease
• Having kidney disease
• Having an underactive thyroid, also called hypothyroidism
• Drinking large amounts of alcohol
• Eating a diet high in processed sugars and simple carbohydrates
• Not getting enough physical activity

Certain medicines can also raise your levels. These include steroids, beta-blockers, and some birth control pills.¹

Triglycerides vs. cholesterol

Hypertriglyceridemia is different from having high cholesterol. Both triglycerides and cholesterol are types of fat found in your blood. However, they have different jobs.¹

Triglycerides store calories that your body does not use right away. They provide energy for your muscles to work. Cholesterol is used by the body to build cells and make certain hormones. Having high levels of either fat can increase the risk of heart disease.¹

However, only severe hypertriglyceridemia carries a high risk of sudden organ swelling. Understanding these differences helps you and your doctor create a better health plan.¹

What are the symptoms of sHTG?

Most people with sHTG do not have any symptoms. You cannot feel high fat levels in your blood. Many people only learn they have the condition after a routine blood test. This is why doctors call it a silent condition.¹

If triglyceride levels become extremely high, physical signs may appear. These signs are caused by fat building up in the body:^1,2

• Eruptive xanthomas – These are small, yellow-red bumps on the skin. They are actually small deposits of fat. They often appear on the eyelids, back, buttocks, or limbs.
• Stomach pain – You may feel sharp pain in the center of your stomach. This pain may spread to your back. This could be a sign of pancreatitis.

What are treatment options for sHTG?

The goal of treatment is to lower your triglyceride levels to under 500 mg/dL. This reduces the risk of pancreatitis. It also helps protect your heart. Doctors usually suggest a mix of lifestyle changes and medicine.^1-3

Lifestyle changes

Diet is the most important part of treatment. People with sHTG should avoid sugar and refined flour. You should also limit or stop drinking alcohol. Alcohol can cause a massive spike in triglyceride levels. Exercise also helps. Aim for 30 minutes of movement most days of the week.¹

Medical treatments

Sometimes lifestyle changes are not enough to lower the numbers. A doctor may prescribe medicine to help. These may include:^1-3

• Fibrates – These are often the first choice for sHTG. They help the liver remove fats from the blood.
• Prescription omega-3 fatty acids – These are highly concentrated fish oils. They are different from the supplements you buy at the store.
• Statins – Doctors use these to lower cholesterol and reduce heart attack risk.
• APOC3 inhibitors – These medicines target a specific protein in the body called APOC3. This protein usually stops the body from breaking down triglycerides. By blocking this protein, these new medicines help the body clear fat much faster.

Before beginning treatment for sHTG, tell your doctor about all your health conditions. Tell them about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

sHTG is serious but manageable

Severe hypertriglyceridemia is a serious but manageable condition. Because it has few symptoms, regular blood work is vital. You can manage your levels through a healthy diet, regular exercise, and medicine. Work closely with your healthcare team to keep tabs on your triglyceride levels in order to keep your heart healthy.^1-3