Higher triglycerides levels convey greater risk.222 Patients with triglycerides from 500 to 999 mg/dL are at risk of developing unrec- ognized marked increases in triglycerides, leading to pancreatitis. Most cases of severe hypertriglyceride- mia have a genetic component, but the hallmark of hypertriglyceridemic pancreatitis is the combination of both genetic and acquired causes of elevated triglycer- To prevent acute pancreatitis, it is reasonable to reduce triglycerides whenever levels exceed 500 mg/ dL. This reduction can be achieved by addressing and eliminating the underlying factors by implementing a very low-fat diet223 and by adding fibrates or omega-3 fatty acids for patients with persistently elevated These are the most reli- able therapies to reduce triglycerides to a safer level. If a fibrate is necessary in a patient being treated with a statin, fenofibrate is safer than gemfibrozil because of a lower risk of severe myopathy.227 Severe hyper- triglyceridemia during pregnancy is best managed in consultation with a lipid specialist.228 Knowledge Gaps and Future Research Areas where our knowledge is limited and therefore would benefit from further research include the following: Combination therapy (combined EPA/DHA com- pared with IPE). The effect that placebo composition might have on lipids and outcomes (eg, mineral oil versus corn oil). Recommendations for Glucose Referenced studies that support recommendations are summarized in online Data Supplements 14 and 15. 