For two years after my first attack I could tell you my lipase, my amylase, and roughly nothing else. Triglycerides were a line on a lab printout I skipped past on the way to the numbers I’d been taught to care about.
Then I learned that for a chunk of patients, that skipped line is the whole story.
Where the risk line sits
Normal fasting triglycerides are under 150 mg/dL. The FDA defines severe hypertriglyceridemia as 500 mg/dL or higher, and guidelines recommend bringing levels down above that mark specifically to reduce the risk of acute pancreatitis. In the two trials behind the new approval, the average patient came in at 1,116 mg/dL. That is seven times the normal ceiling.
If your attacks came with no gallstones and no drinking history, and nobody has run a fasting lipid panel, that is a reasonable thing to ask about.
What changed in June
On 24 June 2026 the FDA approved Tryngolza (olezarsen), a once-monthly injection, to lower triglycerides and reduce the risk of acute pancreatitis in adults with severe hypertriglyceridemia. It’s the first treatment allowed to make that second claim, because earlier triglyceride drugs never had enough pancreatitis events in their trials to prove attacks went down.
Across the two trials in 1,061 adults, triglycerides fell 49 to 72 percent against placebo at six months. The most common problems were injection site reactions and raised liver enzymes, which is why liver testing is built into how it’s prescribed.
A related drug, Redemplo (plozasiran), was approved in November 2025 for familial chylomicronemia syndrome, a rare inherited cause of extreme triglycerides and repeat pancreatitis.
What none of this changes
Diet stays in the picture. Both approvals are worded as an addition to diet, not a replacement for it. The FDA’s own summary of standard care for severe hypertriglyceridemia lists a low-fat diet, treating obesity and diabetes, exercise, and limited to no alcohol.
For us, alcohol is not “limited”. It’s zero. That has been my line since the second hospital stay and it doesn’t move because a drug got approved.
The practical version
Ask for a fasting lipid panel if you’ve never had one since your attack. Write the number down. If it’s high, the conversation with your doctor is about cause: is this genetic, is it diabetes driven, is it a medication, is it diet. Different causes, different fixes.
Stepan’s Rule: know your own numbers before you read anyone’s headline. Fat budget in grams, fasting triglycerides, HbA1c, faecal elastase. Four numbers. They turn “am I doing this right” into something you can actually check.
I’m a patient writing from experience and published sources. This is not medical advice, and no drug decision should come from a blog post.
The book has the full numbers chapter: which tests to ask for, what the results mean in patient language, and the fat budget in grams that everything else hangs off. Get PancreasZen.