High triglycerides increase the risk of cardiovascular disease, including in people who are already taking statins. The value is most meaningful in combination with HDL cholesterol, blood sugar and body composition, and less so as a standalone number.
Triglycerides are fats in your blood that play an important role in cardiovascular disease. The European guidelines for lipid management (ESC/EAS 2019) explicitly recognise triglycerides as a relevant risk factor alongside the better-known LDL cholesterol ('bad cholesterol'). An elevated triglyceride level is therefore not a minor detail, but belongs in the overall picture of your cardiovascular health (PMID 31504418).
A particularly important insight from recent research is that high triglycerides can increase the risk of cardiovascular disease even in people whose LDL cholesterol has already been substantially lowered with statins. This is referred to as 'residual risk'. There is growing evidence that triglyceride-rich particles in the blood play a causal role in this. In statin users with high triglycerides, EPA (a specific fish oil fatty acid) was shown to reduce both triglyceride levels and the number of cardiovascular events (PMID 33257928).
Your triglyceride level becomes even more valuable when viewed in relation to your HDL cholesterol ('good cholesterol'). This ratio is called the Atherogenic Index of Plasma (AIP). Research shows that people in the highest AIP group had a 22% greater chance of cardiovascular disease compared with the lowest group (HR 1.22). In addition, a high AIP is associated with metabolic syndrome, a cluster of risk factors such as abdominal fat, high blood sugar and high blood pressure (PMID 39856691).
Triglycerides also play a role in the so-called TyG index, a measure of insulin resistance that combines triglycerides and blood sugar. A higher TyG index is associated with an 18% increased risk of cardiovascular disease over a period of 9 years, and the risk increases even more sharply above a certain threshold value (PMID 40065297). When the TyG index is combined with a measure of abdominal fat, its predictive value is further enhanced: people with both high TyG values and a large amount of visceral (abdominal) fat had a 75% greater chance of cardiovascular disease compared with the reference group (PMID 39920683).
A striking finding is that people with a large amount of abdominal fat but a relatively low TyG index appeared to have the highest risk of all (HR 1.87). This shows that triglycerides can never be viewed in complete isolation from other risk factors such as body composition, blood sugar and overall physical condition. The combination of high triglyceride-glucose values with physical frailty was also shown in several studies to carry a strongly elevated risk of cardiovascular disease and stroke (PMID 39604987, PMID 40759963).
In summary: your triglyceride level is certainly important, but must always be assessed as part of a broader picture, together with your HDL cholesterol, blood sugar, waist circumference and overall physical condition. Treating triglycerides through lifestyle changes (less sugar, alcohol and refined carbohydrates, more physical activity) or medication can be worthwhile, particularly when other risk factors are also present.
All claims are based on observational studies and review articles (not randomised trials for most outcomes). The associations are statistically robust but largely associative in nature, not proven causal, with the exception of triglyceride-rich lipoproteins for which growing causal evidence exists (PMID 33257928). The ESC/EAS guideline (PMID 31504418) provides stronger normative evidence. None of the studies demonstrate direct harm from treatment.