High Triglycerides: Why They Matter and How to Lower Your Numbers

Triglycerides are a type of fat that circulate in the blood. They’re closely related to cholesterol, and a typical cholesterol blood test will measure triglyceride levels. People with high cholesterol often have high triglycerides, though that’s not always the case. Like high cholesterol, high triglycerides can put you at risk for heart disease and stroke. They can also cause other problems — like liver disease and pancreatitis. 

What you eat and how active you are can have a big effect on your number. In some cases, high triglycerides can be genetic. We’ll go over the important basics about triglycerides — and what you can do to keep your numbers in the safe zone.

What are triglycerides?

Triglycerides are a form of fat that circulates in the bloodstream. They’re an important source of energy for your body. You get triglycerides from the food you eat. Your liver will also make triglycerides, even if you eat very little fat. And if you eat more food than your body needs, the liver will store some of the extra calories as triglycerides. 

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Why is your triglyceride level important? 

It’s important to know your triglyceride level. That’s because it can cause health problems when it’s high. And it’s important to check your level because high triglycerides do not usually cause symptoms until a serious condition develops. For most people that means a blood test every 5 years. If you have diabetes, heart disease, or other health conditions, you may need more frequent screening. 

In general, a triglyceride level over 150 mg/dL is considered high. Here’s why this is a problem:

• At levels over 150 mg/dL, you’ll have a higher risk for heart disease and stroke than someone with a lower number.

• High triglycerides can also lead to fatty liver disease. This does not usually cause symptoms. But sometimes fatty liver can lead to liver failure.

• Levels over 500 mg/dL will put you at risk for pancreatitis. This condition causes severe belly pain, nausea, and vomiting. And if it’s left untreated, this condition can be deadly.

• Chylomicronemia syndrome can happen with levels over 1,000 mg/dL. This condition can cause nerve damage and memory loss. It can also lead to xanthomas — fat deposits on the skin or tendons.

Xanthomas may be the first warning sign of high triglycerides. They often show up on the palms, elbows, and Achilles tendons. They’re usually yellow, but sometimes they can be red. If you notice these on your skin, it’s a good reason to have your triglycerides checked. 

What causes high triglycerides? 

About 1 in 3 Americans have high triglycerides. A lot of things can affect your levels: 

• Diet: Many different foods will raise your triglyceride levels, like starchy, refined carbohydrates. Also on the list are sugary foods and drinks as well as high-fat foods.

• Waist size: If your waist size is 35 inches or more (people assigned female at birth) or 40 inches or more (people assigned male at birth), then you’re more likely to have high triglycerides.

• Health condition: Diabetes, low thyroid, and chronic kidney disease are all linked to higher triglyceride levels.

• Alcohol: If you have more than 4 drinks per day, your triglyceride levels may rise.

• Tobacco: Smoking and chewing tobacco can both raise triglycerides.

• Activity level: People with a less active lifestyle are at increased risk of high triglycerides. 

• Genetics: Many different genes affect triglycerides. Between 1% and 5% of people have high triglycerides due to genetics.

Many common medications can raise triglycerides, including:

• Certain beta blockers, like atenolol, metoprolol, and propranolol

• Some diuretics, like hydrochlorothiazide and furosemide

• Oral forms of estrogen

• Oral steroids, like prednisone

• Some antivirals, including protease inhibitors used to treat HIV

• Some psychiatric medications, including antipsychotics such as clozapine and chlorpromazine

• Oral retinoid drugs that treat skin conditions

How do you measure triglycerides? 

A blood test measures triglyceride levels. Your provider may want you to be fasting, but that’s not always necessary. In fact, high levels when you’re not fasting may be a better predictor of heart disease risk.

Triglycerides can vary from one day to the next. So if you eat a very fatty or starchy meal the night before your blood test, it will usually raise your triglyceride level. 

But genetically high triglycerides will be high no matter what you eat. If you know that high triglycerides run in your family, avoid foods like pasta, ice cream, or steak for 1 to 2 days before your blood test. That will give your provider a clearer look at your baseline level. 

How can you lower your triglycerides? 

If your triglyceride level is high, your provider may also look for other medical conditions that may cause this. They might check the function of your liver, kidney, and thyroid. And if you’re taking one of the medications we listed above, they may switch you to an alternative medication that won’t affect your levels.

But even if there’s no medical cause, some simple lifestyle changes may help you lower your triglyceride level. These include:

• Following a Mediterranean diet

• Doing physical activity consistently, especially aerobic exercise

• Maintaining a weight that is in a healthy range for you

• Keeping your blood sugar at a normal level (if you have diabetes)

• Quitting tobacco

• Limiting alcohol

Even if you inherit some of the genes for high triglycerides, a healthy lifestyle may help. But some people still need a little extra help. And if your numbers remain high, you may need medication to keep your levels in a normal range. Your provider can help find the best choice for you.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, and the American Society of Echocardiography.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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