Treatment Overview

You can use diet and lifestyle changes to lower triglyceride levels. These changes may be especially good at lowering borderline-high levels (150 to 199 mg/dL) back to normal levels (less than 150 mg/dL).

Diet and lifestyle changes include:

• Staying at a healthy weight.
• Limiting fat and sugars.
• Being more active.
• Limiting alcohol.

You may also take medicines to lower triglyceride levels. Medicines may be used if you have risk factors for coronary artery disease (CAD). In this case, your doctor may first want to lower your LDL ("bad") cholesterol level and raise your HDL ("good") cholesterol level before adding medicine to lower your triglycerides.

For more information on target levels and treatment for high cholesterol, see the topic High Cholesterol.

Use this Interactive Tool: Are You at Risk for a Heart Attack? to calculate your risk of a heart attack based on your cholesterol levels and other factors.

Initial treatment

Diet and lifestyle changes are the first steps you will take to lower triglyceride levels.

Diet and lifestyle changes include:

• Staying at a healthy weight or reducing calories to lose weight.
• Limiting the amount of carbohydrate and unhealthy fat that you eat.
• Being more active.
• Limiting alcohol.
• Not smoking.
• Keeping blood sugar in a target range if you have diabetes.

Adding fish oils (omega-3 fatty acids) to your diet may lower triglyceride levels. You can add fish oil by eating fish at least 2 times a week or by taking supplements. Oily fish with lots of omega-3 fatty acids include salmon, tuna, and mackerel.

You may want to try Therapeutic Lifestyle Changes (TLC) and the Therapeutic Lifestyle Changes (TLC) diet. TLC is a combination of diet and lifestyle changes that can lower your cholesterol. The following information can help you get started with the TLC diet:

• Therapeutic Lifestyle Changes (TLC) diet
• Sample menu for the TLC diet
• Tips for success with the Therapeutic Lifestyle Changes (TLC) diet

To reduce carbohydrate in your diet, you may want to learn about the amount of carbohydrate in various foods.

Alcohol has a particularly strong effect on triglycerides. Regular, excessive use of alcohol or even a one-time drinking binge can cause a significant increase in triglycerides. Binge drinking can cause a spike in your triglycerides that may trigger pancreatitis. Your doctor will want you either to stop or to limit the amount of alcohol you drink.

Before you increase your activity, check with your doctor to be sure it is safe. You may also want to talk with a dietitian to design a nutrition program that is right for you.

Your doctor will also look for anything else that might be causing your high triglycerides, such as hypothyroidism, poorly controlled diabetes, kidney disease, or medicines. Your doctor may adjust or stop any medicines that might raise your triglyceride level.

Ongoing treatment

If your triglycerides are still high after you make lifestyle changes, you may need to take medicine as well. Whether your doctor prescribes medicine for high triglycerides depends on more than just your triglyceride number. Your doctor will also look at your cholesterol levels and other risk factors for heart disease before prescribing a medicine for high triglycerides.

If you have high cholesterol and other risk factors for heart disease, you may need a combination of medicines that target the different types of cholesterol. The medicines that you might take are:

• Fibrates.
• Nicotinic acid.
• Statins.

Statins are used to lower LDL (bad) cholesterol. Statins may also lower triglycerides. If you have both high LDL cholesterol and high triglycerides, your doctor may first prescribe statins to lower your LDL and later prescribe a medicine to lower your triglycerides.

If your triglycerides are very high even after lifestyle changes, your doctor may first use medicine to lower your triglycerides to prevent damage to your pancreas.

Fibrates (fibric acid derivatives) should be used with caution by people who are also taking statins. There is a greater risk of developing a life-threatening muscle problem called rhabdomyolysis, which can lead to kidney failure. So it is important that your kidneys and liver are healthy before you take this combination of medicines. If you have any muscle problems or pain, report it immediately to your doctor.

Treatment if the condition gets worse

If you have not previously been taking medicines for high triglycerides, you probably will start. If you have been taking medicines but they have not been effective, your doctor may change your dosage or add new medicines. The medicines that you might take are:

• Fibrates.
• Nicotinic acid.
• Omega-3 fatty acids (fish oil).
• Statins.

If you are taking a statin, you need to be extra careful if you are also taking fibrate medicines. There is a greater risk of developing a life-threatening muscle problem called rhabdomyolysis, which can lead to kidney failure. Before you can take this combination of medicines, your kidneys and liver must be healthy and function normally. If you have any muscle problems or pain, report it immediately to your doctor.

Your doctor may prescribe an omega-3 fatty acids medicine (such as Lovaza). You can get omega-3 fatty acids from eating oily fish like salmon or tuna. But this medicine is a highly concentrated form of omega-3 fatty acids, which can lower triglyceride levels. This medicine is used in combination with diet and lifestyle changes for high triglycerides. This medicine may raise LDL cholesterol levels slightly, so your doctor may closely watch your cholesterol levels if you take Lovaza.

You may need to think about how well you are able to follow your plan for making lifestyle changes. You may need to get some help to meet your goals. Consider meeting with a registered dietitian or nutritionist who can work with you to make healthier food choices. Do not overlook the importance of increasing your activity-join a health club or consult a personal trainer who can design a program for you to help make exercising interesting, fun, and more effective. You may want to choose walking to help increase activity in your life.

Fitness: Walking for wellness