Causes of hypertriglyceridemia (HTG) vary according to their severity and to their character pure or mixed. Environmental factors including caloric intake excess, fructose overload, alcohol consumption, metabolic syndrom, diabetes, and drug exposure are mostly involved in pure, mild HTG. In contrast, the main etiology of mixed HTG (combined dyslipidemia) is familial combined hyperlipidemia which is commonly associated with metabolic syndrome. Major HTG (> 10 g/L) results mostly from genetic disorder in lipid metabolism with a variable contribution of environmental factors. The complications of HTG are an increased risk of acute pancreatitis (TG > 10 g/L) and a controversial atherogenic risk. Lifestyle modification is the treatment cornerstone. Nevertheless, statins are generally considered as the first drug if a medication is necessary for mixed hyperlipidemia. Fibrates may be used in combination with statin for patient with high atherogenic risk and simultaneous residual hypertriglycéridémie and low HDLc or in high risk patient with severe pure hypertriglyceridemia.