Triglycerides

•RCT evidence— REDUCE-IT, FIELD; pancreatitis risk threshold

What it measures

Triglycerides circulate primarily in VLDL and chylomicron particles. Fasting triglycerides reflect liver VLDL output; non-fasting include post-prandial chylomicrons.

Why they matter

• High triglycerides almost always indicate insulin resistance and metabolic syndrome.
• Very high triglycerides (>500 mg/dL) carry acute pancreatitis risk.
• Triglyceride-rich remnants are themselves atherogenic.
• The TG/HDL ratio (target <1.5 in mg/dL) is a useful insulin-resistance proxy.

What lowers triglycerides

• Weight loss.
• Reducing refined carbohydrates and sugar.
• Alcohol moderation/elimination.
• Aerobic exercise.
• Omega-3 (4 g/day prescription dose).
• Fibrates (mostly for severe hypertriglyceridaemia and pancreatitis prevention; cardiovascular benefit modest).
• SGLT2 inhibitors, GLP-1 agonists.

Note on fenofibrate

Multiple fenofibrate cardiovascular outcome trials (FIELD, ACCORD-Lipid) have been broadly neutral. Its main role today is pancreatitis-risk reduction in severe hypertriglyceridaemia.

Related entries

HDL-C, TG/HDL ratio, Fasting insulin, Omega-3, REDUCE-IT.