High Triglycerides: Causes and Treatment

High triglycerides mean you have more fat circulating in your blood than is healthy, usually 150 mg/dL or higher. The most common causes are added sugar, refined carbs, alcohol, excess weight, and diabetes, and triglycerides respond to changes in those faster than almost any other number on your lipid panel.

What are triglycerides?

Your body stores excess calories (from sugar, alcohol, or fat) mainly as triglycerides, its usable energy reserve. A triglyceride test measures how much of this fat circulates in your blood at the time of the test, so what you ate and drank recently moves triglycerides more than it moves LDL cholesterol (LDL-C) or ApoB.

What level of triglycerides is high?

150 mg/dL or higher is high, and 500 or higher is very high, with a risk of pancreatitis. These are the long-standing categories from the National Cholesterol Education Program:

• Normal: below 150 mg/dL
• Borderline high: 150 to 199 mg/dL
• High: 200 to 499 mg/dL
• Very high: 500 mg/dL or above, which carries a real risk of acute pancreatitis, a medical emergency, in addition to cardiovascular risk

The 2026 ACC/AHA dyslipidemia guideline counts triglycerides that stay at 150 mg/dL or higher fasting (175 or higher non-fasting) as a risk-enhancing factor, and adds ApoB goals for people with triglycerides of 150 to 499 (UIC Drug Information Group summary).

What causes high triglycerides?

Most often, diet, alcohol, excess weight, and blood sugar problems; less often, genes or medications.

• Added sugar and refined carbohydrates: the single biggest dietary driver for most people
• Alcohol: even moderate regular intake raises triglycerides meaningfully in many people
• Excess weight, particularly around the abdomen
• Poorly controlled diabetes or prediabetes
• Genetics: a minority of people have a hereditary triglyceride disorder that produces very high levels regardless of diet
• Certain medications, including some birth control pills, steroids, and beta blockers

Why do triglycerides matter for heart disease?

High triglycerides are linked to higher cardiovascular risk, though the relationship is more entangled with other factors (low HDL, insulin resistance, excess weight) than LDL's more direct, causal relationship with plaque formation. Very high triglycerides also carry an independent risk of acute pancreatitis, unrelated to cardiovascular disease.

Non-HDL cholesterol (total cholesterol minus HDL) and ApoB capture both LDL-related and triglyceride-related particles in one number, so the 2026 guideline uses them alongside LDL when triglycerides are high. You can calculate your own non-HDL cholesterol with our free LDL and non-HDL calculator.

How do you lower triglycerides?

Cut added sugar, refined carbs, and alcohol, lose excess weight, and get blood sugar under control; medicine is added when levels stay high or reach 500. Triglycerides respond to lifestyle changes faster, and by more, than LDL does:

1. Cut added sugar and refined carbohydrates. This alone can lower triglycerides substantially within weeks.
2. Reduce or eliminate alcohol. For some people, alcohol is the single biggest driver, and cutting it produces a fast, measurable drop.
3. Lose excess weight, particularly visceral fat.
4. Increase omega-3 intake, from fatty fish or, for significantly elevated levels, prescription-strength icosapent ethyl (Vascepa), which reduced major cardiovascular events by 25% in the REDUCE-IT trial. That trial enrolled people already on a statin, with triglycerides of 135 to 499 mg/dL and either heart disease or diabetes plus other risk factors.
5. Get diabetes or prediabetes under control, if present, since insulin resistance drives triglyceride production directly.

For very high triglycerides (500 mg/dL or above), medication (fibrates, high-dose omega-3s) is often needed immediately alongside lifestyle changes, specifically to reduce pancreatitis risk while the underlying causes are addressed.

Summary

Triglycerides respond to lifestyle faster than most numbers on your lipid panel. An alarming number can often improve substantially within weeks of cutting sugar and alcohol, although LDL-C and ApoB remain the numbers most directly tied to long-term cardiovascular risk.

At Preval Health, triglycerides are part of every lipid panel we review, both for their own risk contribution and because a very high number raises the urgency. When triglycerides are high, our advanced lipid testing adds ApoB, which shows the particle count that LDL cholesterol can miss.