Hypertriglyceridemia Management — free guideline decision tool

This tool directs hypertriglyceridemia management by triglyceride level and ASCVD risk, distinguishing pancreatitis prevention in severe disease from cardiovascular risk reduction in mild-moderate disease.

Severe (≥ 500 mg/dL) → fibrate + very-low-fat diet + treat secondary causes (± ω-3), statin only after TG < 500. Mild-moderate (150–499) → lifestyle + statin by risk; high-risk on statin with TG ≥ 150 → add icosapent ethyl.

Use to choose the main line: severe TG (≥ 500 mg/dL) prioritizes a fibrate and very-low-fat diet to prevent pancreatitis, while mild-moderate TG is lifestyle-led with a statin and possible icosapent ethyl.

In severe hypertriglyceridemia the goal is preventing acute pancreatitis, so a fibrate (not a statin alone) leads, alongside a very-low-fat diet and secondary-cause treatment. (original synthesis · not guideline verbatim) Icosapent ethyl (REDUCE-IT) lowers major cardiovascular events ~25% in high-risk patients with persistent TG ≥ 150 on a statin. Uncontrolled diabetes, hypothyroidism, alcohol, and certain drugs are common secondary drivers worth correcting first.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Triglyceride level Mild-moderate (150–499 mg/dL / 1.7–5.6 mmol/L), ASCVD or high diabetes risk No → Result: Main line Lifestyle-focused + statin by risk（Lifestyle (first-line): Mild-moderate (150–499 mg/dL / 1.7–5.6 mmol/L): 5–10% weight loss, limit added sugar and alcohol, limit total fat, ≥ 150 min/week moderate exercise, Secondary factors: Identify and treat secondary causes (uncontrolled diabetes, hypothyroidism, kidney disease, certain drugs), Statin: Statin by ASCVD risk (10-year risk ≥ 7.5% or elevated LDL); statins lower both TG and cardiovascular events） Inputs: Triglyceride level Severe (≥ 500 mg/dL / ≥ 5.6 mmol/L), ASCVD or high diabetes risk Yes → Result: Main line Fibrate for pancreatitis prevention + very-low-fat diet（Pancreatitis prevention (priority): Severe (≥ 500 mg/dL / ≥ 5.6 mmol/L): first-line fibrate (fenofibrate, preferred over gemfibrozil when combined with a statin) to lower TG and prevent acute pancreatitis; do not use a statin alone; first target is to lower TG to < 500, Lifestyle: Very-low-fat diet (≥ 1000 mg/dL: fat 10–15% of intake; 500–999: 20–25%), alcohol cessation, limit refined carbs/added sugar; weight loss; regular exercise, Secondary factors: Identify and treat secondary causes (especially uncontrolled diabetes, hypothyroidism, certain drugs, alcohol use) — often markedly lowers TG）