From the Guidelines
The first-line treatment for hypertriglyceridemia involves lifestyle modifications and pharmacological interventions.
Key Lifestyle Modifications
- Dietary counseling
- Weight loss in patients who are overweight or obese
- Reduced intake of dietary fat and simple carbohydrates ### Pharmacological Interventions For patients with triglyceride levels ≥ 500 mg/dL, fibrates such as fenofibrate (135-200 mg/day) or gemfibrozil (600 mg twice daily) are recommended as initial therapy 1, 2. Alternatively, omega-3 fatty acids (2-4 grams/day) may be considered for patients with triglyceride levels ≥ 200 mg/dL but < 500 mg/dL 3, 4. Statins, such as atorvastatin (10-80 mg/day) or rosuvastatin (5-40 mg/day), may also be used as adjunctive therapy to manage concomitant elevated low-density lipoprotein cholesterol levels 5, 4. Some key points to consider:
- The treatment goal for patients with moderate hypertriglyceridemia is a non–high-density lipoprotein cholesterol level of 30 mg per dL (0.78 mmol per L) higher than the low-density lipoprotein goal, as recommended by the NCEP ATP III 1.
- Fibrates, niacin, and n-3 fatty acids, alone or in combination, should be considered in patients with moderate to severe hypertriglyceridemia 1, 3.
- Statins have a modest triglyceride-lowering effect (typically 10% to 15%) and may be useful to modify cardiovascular risk in patients with moderately elevated triglyceride levels 1, 5. Treatment duration is typically long-term, with regular monitoring of triglyceride levels and adjustment of therapy as needed to achieve target levels 5, 4.
From the FDA Drug Label
The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy. Physical exercise can be an important ancillary measure Diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus should be looked for and adequately treated.
The first-line treatment for hypertriglyceridemia is dietary therapy and management of excess body weight and excess alcohol intake, as well as physical exercise.
- Dietary therapy should be specific for the type of lipoprotein abnormality.
- Physical exercise can be an important ancillary measure.
- Contributory diseases such as hypothyroidism or diabetes mellitus should be looked for and adequately treated. 6 7 8
From the Research
First-Line Treatment for Hypertriglyceridemia
The first-line treatment for hypertriglyceridemia typically involves lifestyle modifications, including:
- Cessation of alcohol consumption
- Reduced intake of rapidly metabolized carbohydrates
- Weight loss
- Blood sugar control
- A low saturated fat, carbohydrate-controlled diet
- Regular aerobic exercise
- Smoking cessation 9, 10
Pharmacological Treatment
When lifestyle modifications are not sufficient, pharmacological treatment may be necessary. The choice of medication depends on the severity of hypertriglyceridemia and the presence of other lipid abnormalities. Options include:
- Fibrates, which can lower triglyceride concentrations 9, 10, 11
- Omega-3 fatty acids, which can lower triglyceride levels 9, 10, 11, 12
- Statins, which are usually the first-line treatment for mild to moderate hypertriglyceridemia, as they can reduce low-density lipoprotein cholesterol levels and also lower triglyceride levels 11, 13
- Icosapent ethyl, which may be added to background statin therapy to further reduce cardiovascular disease risk in patients with moderate hypertriglyceridemia 13
Special Considerations
In patients with severe hypertriglyceridemia (triglyceride levels ≥ 500 mg/dL), prescription omega-3-acid ethyl esters (P-OM3) can reduce triglyceride levels by up to 45% 12. Additionally, patients with purely genetic types of hypertriglyceridemia, such as familial chylomicronemia syndrome, should be treated in specialized outpatient clinics 9.