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American College of Cardiology Releases Guidance to Address ASCVD Risk for Patients With Persistent Hypertriglyceridemia

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Released in July 2021, The American College of Cardiology’s Expert Consensus Decision Pathway addresses a gap in the management of high-risk atherosclerotic cardiovascular disease (ASCVD) in patients with persistent hypertriglyceridemia.Persistent hypertriglyceridemia is defined as fasting triglycerides (TG) ≥ 150 mg/dL following lifestyle intervention, maximally tolerated statin therapy, and evaluation for secondary causes.

Recognizing hypertriglyceridemia as a risk-enhancing factor for ASCVD, the Decision Pathway utilizes the 2018 AHA/ACC/multisociety guidelines and incorporates data from long-term outcome trials published after the guidelines for TG risk-based nonstatin therapies, including omega-3 fatty acids, icosapent ethyl, fibric acid derivatives, and others.

These new treatment algorithms address groups with mild to moderate (fasting TG ≥ 150 mg/dL or nonfasting TG ≥ 175mg/dL and <500 mg/dL) and severe (fasting TG ≥ 500 mg/dL and especially TG ≥1000 mg/dL) hypertriglyceridemia, for which the goal is to reduce ASCVD and pancreatitis risk, respectively. While treatment algorithms differ based on TG level, patient age, and additional ASCVD risk factors, all emphasize glycemic control in patients with diabetes mellitus, optimization of lifestyle and diet, evaluation for secondary causes of elevated TG, and use of 2018 AHA/ACC/multisociety guideline-directed statin therapy.

Cardi-OH’s evidence-based resources on smoking cessationdiet, and diabetes are available to assist clinicians and teams in management of ASCVD risk.


  1. Virani SS, Morris PB, Agarwala A, et al. 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021; 78(9):960-993. doi.org/10.1016/j.jacc.2021.06.011.
     
  2. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:e285–350. doi: 10.1016/j.jacc.2018.11.003.
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