Triglycerides 150 to 199 mg/dL

A fasting triglyceride of 150 to 199 mg/dL is borderline high in ATP III, the NHLBI panel report of May 2001: "Borderline-high triglycerides: 150-199 mg/dL". ATP III's table of new features says it "Lowers the triglyceride classification cutpoints to give more attention to moderate elevations." Its instruction for this band: "When triglycerides are borderline high (150-199 mg/dL), emphasis should also be placed on weight reduction and increased physical activity." Reaching the LDL cholesterol goal stayed the primary aim.

The same 150 is a metabolic syndrome criterion. A fasting triglyceride of 150 or higher is one of the five risk determinants in ATP III's Table 8, and "the diagnosis of the metabolic syndrome is made when three or more of the risk determinants shown in Table 8 are present." A result in this band supplies one of the three.

The 2026 guideline has no borderline high category for adults. The ACC/AHA dyslipidemia guideline published online March 13, 2026, which "retires and replaces" the 2018 cholesterol guideline, treats every fasting value from 150 to 499 as one tier, with a starting line that depends on the sample: 150 fasting, 175 nonfasting. So a nonfasting 150 to 174 sits under the 2026 nonfasting threshold, while a nonfasting 175 to 199 meets it.

The first steps. After evaluation and management of secondary causes, the diseases and drugs that can raise triglycerides, Section 4.2.9 recommends lifestyle change "as a first-line approach to reduce TG levels". Section 4.1.2.2, Recommendation 4 (Class 1), sets the dose: weight loss of 5 to 10 percent if you carry extra weight, at least 150 minutes a week of moderate-to-vigorous activity, and upper and lower body resistance exercise 2 days a week. The guideline reports that "A 5% to 10% weight loss can result in a reduction in TG of 20% to 30%." A meta-analysis of 73 trials found TG fell 4 mg/dL for every kilogram lost.

When to retest. Most of the guideline's later steps apply only to a persistent elevation, which it defines on a fasting value taken after secondary causes are handled, after "a minimum of 4 to 12 weeks of lifestyle management", and on a stable, maximally tolerated statin dose if your risk calls for one. Table 13 then counts triglycerides "persistently ≥175 mg/dL (2 mmol/L) (if nonfasting) and ≥150 mg/dL (1.7 mmol/L) (if fasting)" as a risk enhancer. The guideline weighs risk enhancers for adults without ASCVD (atherosclerotic cardiovascular disease) whose 10-year risk on the PREVENT-ASCVD equations is borderline, 3 to under 5 percent, when deciding whether to start lipid-lowering therapy. It attaches a caution: an independent association with ASCVD risk "does not necessarily mean the risk enhancer improves risk prediction over the PREVENT-ASCVD equations."