2-2 S4.5.2-6 IIa B-R In adults 40 to 75 years of age with severe hypertriglyceridemia (fasting triglycerides 500 mg/dL [ 5.6 mmol/L]) and ASCVD risk of 7.5% or higher, it is reasonable to address reversible causes of high triglyceride and to initiate statin therapy.S4.5.2-3 S4.5.2-5,S4.5.2-7,S4.5.2-8 IIa B-NR In adults with severe hypertriglyceridemia (fasting triglycerides 500 mg/dL [ 5.7 mmol/L]), and especially fasting triglycerides 1000 mg/dL (11.3 mmol/L)), it is reasonable to identify and address other causes of hypertriglyceridemia), and if triglycerides are persistently elevated or increasing, to further reduce triglycerides by implementation of a very low-fat diet, avoidance of refined carbohydrates and alcohol, consumption of omega-3 fatty acids, and, if necessary to prevent acute pancreatitis, fibrate Synopsis Two categories of hypertriglyceridemia consist of moder- ate hypertriglyceridemia (fasting or nonfasting triglycer- ides 175-499 mg/dL [2.0-5.6 mmol/L]) and severe hyper- triglyceridemia (fasting triglycerides 500 mg/dL [ 5.6 mmol/L]). In the former, excess triglycerides are carried in VLDL. In the latter, most patients have elevated VLDL plus chylomicrons. VLDL are believed to be atherogenic, similar to LDL. There are many causes of elevated VLDL, and it is reasonable to reduce their levels to reduce risk of ASCVD. With severe hypertriglyceridemia, elevations of VLDL raise risk of ASCVD, but increases in chylomi- crons impart risk of acute pancreatitis. Therapies should address excesses in both lipoproteins. Recommendation-Specific Supportive Text 1. In patients with moderate hypertriglyceride- mia, it is reasonable to reduce both atherogenic VLDL and associated risk factors by nonpharma- cological means where possible. 