Hypertriglyceridaemia (raised triglycerides)

Endocrinology and metabolism · Abnormal laboratory result · updated 2026-11-01

BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.

Frequency: One third of adults in the United States (NHANES survey 1999-2004) have triglycerides ≥ 1.5 g/L; 1.7% exceed 5 g/L ^[1]

Triglycerides 1.5 to 8.8 g/L (1.7 to 10 mmol/L): recheck and look for a cause

Fasting sample.

From 4.4 g/L (5 mmol/L): acute abdominal pain, emergency department without waiting for the tests (acute pancreatitis).

Follow-up fasting lipid profile
Fasting plasma glucose
Serum creatinine with eGFR
AST
ALT
GGT
FBC with platelets (for the FIB-4 score)
TSH
Apolipoprotein B (if mixed hyperlipidaemia or severe form to be typed)if neededIf mixed hyperlipidaemia or severe form to be typed: the French consensus bases the diagnosis on the lipid profile and apolipoprotein B, and recommends this measurement to assess risk in moderate hypertriglyceridaemia and to characterise mixed hyperlipidaemia ^[2]. The NABM reserves it for rare genetic diseases and extreme forms of complex dyslipidaemia, on explicit prescription, allows it at the laboratory scientist's initiative above 3.4 g/L of triglycerides, and states that outside these indications it has no demonstrated clinical value in common dyslipidaemias ^[3].
HbA1c (if known diabetes)if neededIf known diabetes: hypertriglyceridaemia worsens with poor glycaemic control ^[2]. The French consensus cites HbA1c in addition to fasting plasma glucose ^[2]; the NABM limits its coverage to monitoring of glycaemic control ^[3].
Carbohydrate-deficient transferrin (CDT) (if excessive alcohol consumption suspected)if neededIf alcohol use disorder is suspected, the French consensus proposes CDT or PEth measurement ^[2]; PEth is not listed in the French laboratory fee schedule (NABM) ^[3].

Urine dipstick (proteinuria)
If triglycerides exceed 3.4 g/L (3.9 mmol/L), LDL-cholesterol can no longer be calculated: the laboratory may, on its own initiative, measure apolipoprotein B or direct LDL-cholesterol.

Detailed explanation and international comparison (in French): read it in English (machine translation)

FIB-4 to interpret? To interpret the FIB-4 and decide next steps, see the page "Metabolic dysfunction-associated steatotic liver disease (MASLD): look for advanced fibrosis".

Apolipoprotein A1 and other apolipoproteins (C-II, C-III…), lipoprotein size or subclasses: the NABM states that outside its indications apolipoprotein A1 has no demonstrated clinical value in common dyslipidaemias, and does not list apolipoproteins C-II and C-III ^[3]; the withdrawn Endocrine Society recommendation considered subclasses of no value routinely ^[7].

Fasting sample.

Acute abdominal pain: emergency department without waiting for the tests (acute pancreatitis).
More than 17.7 g/L (20 mmol/L), with no excess alcohol or uncontrolled diabetes to explain it: urgent specialist opinion, without waiting for the follow-up test below.
As soon as this result is known: stop alcohol, restrict fat, review medications, control diabetes.

Fasting lipid profile (triglyceride follow-up)
Fasting plasma glucose
Serum creatinine with eGFR
AST
ALT
GGT
FBC with platelets (for the FIB-4 score)
TSH
Apolipoprotein B (unless already measured by the laboratory)
HbA1c (if known diabetes)if neededIf known diabetes: hypertriglyceridaemia worsens with poor glycaemic control ^[2]. The French consensus cites HbA1c in addition to fasting plasma glucose ^[2]; the NABM limits its coverage to monitoring of glycaemic control ^[3].
Carbohydrate-deficient transferrin (CDT) (if excessive alcohol consumption suspected)if neededIf alcohol use disorder is suspected, the French consensus proposes CDT or PEth measurement ^[2]; PEth is not listed in the French laboratory fee schedule (NABM) ^[3].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Sources (21)