What is the preferred treatment for Hypertriglyceridemia?

From the Guidelines

The preferred treatment for hypertriglyceridemia is lifestyle modifications, including dietary changes and weight loss, with the addition of medication therapy for more severe cases, prioritizing fibrates and omega-3 fatty acids to reduce the risk of pancreatitis and cardiovascular events. According to the most recent and highest quality study 1, hypertriglyceridemia should be addressed with dietary and lifestyle changes, including weight loss and abstinence from alcohol. For severe hypertriglyceridemia, pharmacologic therapy with fibric acid derivatives and/or fish oil may be warranted to reduce the risk of acute pancreatitis. Some key points to consider in the treatment of hypertriglyceridemia include:

• Lifestyle modifications, such as dietary changes and weight loss, as the first-line approach for mild to moderate hypertriglyceridemia
• The use of fibrates, such as fenofibrate, and omega-3 fatty acids, such as icosapent ethyl, for more severe cases
• The importance of monitoring lipid panels regularly to assess treatment efficacy and adjust therapy as needed
• The goal of reducing triglycerides below 150 mg/dL ideally, or at least below 500 mg/dL to prevent pancreatitis
• The use of statin therapy to reduce the risk of cardiovascular events, as indicated by the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) 1.

From the FDA Drug Label

The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. Fenofibrate tablets are indicated as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia.

The preferred treatment for hypertriglyceridemia is dietary therapy.

• Fenofibrate may be used as an adjunctive therapy to diet for the treatment of severe hypertriglyceridemia.
• The initial dose of fenofibrate is 54 mg per day to 160 mg per day, and should be individualized according to patient response.
• The maximum dose is 160 mg once daily 2.

From the Research

Hypertriglyceridemia Treatment Options

The treatment of hypertriglyceridemia typically involves a combination of lifestyle changes and pharmacological interventions.

• Lifestyle modifications, such as improved diet and increased physical activity, are effective in lowering triglyceride levels 3, 4, 5.
• Pharmacological treatment usually starts with statins, although the associated triglyceride reductions are typically modest 3, 6.
• Fibrates are currently the drugs of choice for hypertriglyceridemia, frequently in combination with statins 3, 7, 6.
• Omega-3 fatty acids and niacin can also be used to improve control of triglyceride levels when other measures are inadequately effective 3, 4, 5, 7, 6.

Preferred Treatment Approach

The current approach to the management of hypertriglyceridemia is based on lifestyle changes and, usually, drug combinations (statin and fibrate and/or omega-3 fatty acids or niacin) 3.

• For patients with high triglyceride levels who have borderline or intermediate risk, statins can be considered 5.
• For patients at high risk who continue to have high triglyceride levels despite statin use, high-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality 5.
• Fibrates, omega-3 fatty acids, or niacin should be considered for patients with severely elevated triglyceride levels to reduce the risk of pancreatitis 4, 5, 7.

Special Considerations

• Patients with acute pancreatitis associated with hypertriglyceridemia may require insulin infusion and plasmapheresis if triglyceride levels remain high despite conservative management 5.
• Patients with the very rare purely genetic types of hypertriglyceridemia (familial chylomicronemia syndrome) should be treated in specialized outpatient clinics 4.
• Gene therapy is under development for patients with known genetic abnormalities of triglyceride metabolism 7.