The hypertriglyceridemias comprise a heterogenous group of lipoprotein disorders varying with respect to etiology, lipoprotein pattern, and its major clinical sequelae, i.e. pancreatitis and atherosclerosis. Therefore goals and modalities of treatment should be individualized to a large extent. Behavioral measures like diet, weight control, exercise, reduced alcohol consumption and smoking cessation form the cornerstone of medical management. Lipid lowering drugs should be considered when triglyceride levels exceed 1000 mg/dl to reduce the risk of pancreatitis and in patients at high risk for atherosclerosis, often characterized by a high total cholesterol/HDL ratio, to reduce cardiovascular endpoints.