Hypertriglyceridaemia: Managing High Triglycerides in the UK

Hypertriglyceridaemia is the medical term for having high levels of triglycerides in the blood. Triglycerides are a type of lipid (fat) that your body uses for energy. When you eat, your body converts any calories it doesn't need to use right away into triglycerides, which are stored in your fat cells. Later, hormones release triglycerides for energy between meals.

In the UK, lipid profiles often measure both cholesterol and triglycerides. While cholesterol is used to build cells and certain hormones, triglycerides are primarily for energy storage. Having an excess of these fats can lead to the thickening of artery walls, increasing the risk of cardiovascular disease. According to NICE (National Institute for Health and Care Excellence) guidance, triglycerides are an important component of a full cardiovascular risk assessment.

For most British patients, hypertriglyceridaemia is a 'silent' condition, meaning it rarely causes noticeable symptoms until it reaches dangerously high levels. It is usually detected during routine blood tests, such as the NHS Health Check offered to adults aged 40 to 74.

However, extremely high levels (severe hypertriglyceridaemia) may cause physical signs, including:

• Xanthomas: Small, fatty deposits or yellowish bumps under the skin, often around the eyelids, elbows, or knees.
• Lipidemia Retinalis: A creamy white appearance of the retinal vessels, visible during an eye exam.
• Abdominal Pain: Severe levels can cause inflammation of the pancreas (pancreatitis), leading to intense pain in the upper abdomen.

High triglycerides can be primary (genetic) or secondary (caused by lifestyle or other medical conditions). In the UK, secondary causes are far more common and are often linked to:

• Dietary Habits: High intake of refined sugars, fructose, and saturated fats.
• Alcohol Consumption: Alcohol is high in calories and sugar, and even moderate amounts can significantly raise triglyceride levels.
• Uncontrolled Type 2 Diabetes: High blood sugar levels contribute to lipid imbalances.
• Obesity: Carrying excess weight around the middle is a major risk factor.
• Medications: Certain drugs, such as diuretics, beta-blockers, and some hormonal treatments, can affect lipid levels.

Managing hypertriglyceridaemia focuses on reducing the risk of cardiovascular events and preventing pancreatitis. The first line of treatment is almost always lifestyle modification, following NHS recommendations.

Dietary Changes

Patients are advised to reduce their intake of 'simple' carbohydrates, such as white bread, sugary drinks, and sweets. Increasing intake of oily fish (rich in Omega-3) and fibrous vegetables is highly beneficial. Reducing or eliminating alcohol is often the most effective way to see a rapid drop in levels.

Physical Activity

Regular aerobic exercise helps the body process fats more efficiently. Aiming for at least 150 minutes of moderate-intensity activity a week is the standard UK health goal.

Pharmacological Treatment

If lifestyle changes are insufficient, a GP may prescribe medication. Statins are often used if high cholesterol is also present. However, for specifically high triglycerides, fibrates (such as fenofibrate) are commonly used to reduce the liver's production of VLDL (very-low-density lipoprotein) and speed up the removal of triglycerides from the blood.

Managing a long-term lipid disorder requires regular monitoring and professional advice. You should consider speaking to an online doctor if:

• You have received blood test results showing high triglycerides and need a clear explanation of what they mean for your health.
• You require a cardiovascular risk assessment (QRISK3) to determine if you need preventative medication.
• You are struggling with lifestyle changes and need a structured management plan.
• You need to discuss the side effects of your lipid-lowering medication or require a repeat prescription.

An online consultation allows you to discuss your results and management strategy from the comfort of home, ensuring you stay on track with your long-term health goals.

In the UK, triglyceride levels are measured in millimoles per litre (mmol/L). Generally, the following categories apply:

• Normal: Less than 1.7 mmol/L
• Borderline High: 1.7 to 2.2 mmol/L
• High: 2.3 to 5.6 mmol/L
• Very High: Above 5.6 mmol/L

If your levels are consistently above 10 mmol/L, the risk of acute pancreatitis increases significantly, requiring urgent medical intervention and specialized dietary restriction.