What is the treatment for hypertriglyceridemia?

From the Guidelines

Hypertriglyceridemia treatment should prioritize lifestyle modifications and medications to lower elevated triglyceride levels, with a focus on reducing the risk of pancreatitis and cardiovascular disease, as recommended by the most recent guidelines 1.

Key Components of Treatment

• Lifestyle modifications: dietary changes, weight loss, regular exercise, and strict diabetes control if applicable
• Medication therapy: fibrates, omega-3 fatty acids, and statins for triglyceride levels above 500 mg/dL
• Treatment goals: reduce triglyceride levels, prevent pancreatitis, and lower cardiovascular risk

Medication Options

• Fibrates: fenofibrate 145 mg daily or gemfibrozil 600 mg twice daily
• Omega-3 fatty acids: 2-4 grams daily
• Statins: atorvastatin 10-80 mg or rosuvastatin 5-40 mg daily
• Niacin: 500-2000 mg daily, but with more side effects including flushing

Monitoring and Follow-up

• Lipid panels every 4-12 weeks initially, then every 3-12 months once stable
• Regular assessment of cardiovascular risk factors and adjustment of treatment as needed

Severe Hypertriglyceridemia

• Triglyceride levels above 1000 mg/dL may require combinations of medications and reduction in dietary fat to reduce the risk of acute pancreatitis 1
• Lifestyle interventions, treatment of secondary factors, and avoidance of medications that might raise triglycerides are recommended 1

From the FDA Drug Label

Fenofibrate tablets are also indicated as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia. The initial dose is 54 mg per day to 160 mg per day. Dosage should be individualized according to patient response and should be adjusted if necessary following repeat lipid determinations at 4 to 8 week intervals. The effect of fenofibrate on serum triglycerides were studied in two randomized, double-blind, placebo-controlled clinical trials of 147 hypertriglyceridemic patients

Treatment for Hypertriglyceridemia:

• Fenofibrate is indicated as adjunctive therapy to diet for the treatment of adult patients with severe hypertriglyceridemia.
• The initial dose of fenofibrate for severe hypertriglyceridemia is 54 mg per day to 160 mg per day.
• Dosage should be individualized according to patient response and adjusted as necessary following repeat lipid determinations at 4 to 8 week intervals.
• Fenofibrate has been shown to decrease primarily very low density lipoprotein (VLDL) triglycerides and VLDL cholesterol in patients with hypertriglyceridemia 2, 2, 2.

From the Research

Treatment Options for Hypertriglyceridemia

• Lifestyle modifications, such as cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control, are the most effective ways to lower triglyceride (TG) levels 3
• Pharmacological treatment usually starts with statins, although associated TG reductions are typically modest 4
• Fibrates are currently the drugs of choice for hypertriglyceridemia, frequently in combination with statins 4
• Omega-3 fatty acids, particularly eicosapentaenoic acid ethyl ester, can lower TG levels and reduce the risk of cardiovascular disease in high-risk patients 3, 5, 6
• Niacin can also improve control of triglyceride levels when other measures are inadequately effective 4, 6

Management of Hypertriglyceridemia

• The management of high TG levels starts with dietary changes and physical activity to lower cardiovascular risk 5
• Calculating a patient's 10-year risk of atherosclerotic cardiovascular disease is pertinent to determine the role of medications 5
• Statins can be considered for patients with high TG levels who have borderline or intermediate risk 5
• For patients at high risk who continue to have high TG levels despite statin use, high-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality 5

Combination Therapy

• Concomitant use of prescription omega-3 fatty acids (P-OM3) and fenofibrate (FENO) can result in a greater reduction in TG levels compared to FENO monotherapy 7
• The addition of P-OM3 to stable FENO therapy can also result in a statistically significant reduction in TG levels 7

Special Considerations

• Patients with severely elevated TG levels (≥500 mg/dL) are at increased risk of pancreatitis and may require immediate use of triglyceride-lowering agents 5, 6
• Patients with acute pancreatitis associated with hypertriglyceridemia may require insulin infusion and plasmapheresis if TG levels remain high despite conservative management 5