From the Guidelines
For patients with a history of stroke and hypertriglyceridemia, treatment should focus on both reducing triglyceride levels and preventing recurrent stroke, with icosapent ethyl being considered to reduce cardiovascular risk in individuals with ASCVD or other cardiovascular risk factors on a statin with managed LDL cholesterol but elevated triglycerides. The primary goal is to address hypertriglyceridemia with dietary and lifestyle changes, including weight loss and abstinence from alcohol, as recommended by the most recent guidelines 1.
- Key lifestyle modifications include:
- A Mediterranean or DASH diet
- Limiting alcohol
- Increasing physical activity
- Weight management
- Smoking cessation
- For patients with severely elevated triglycerides (>500 mg/dL), adding a fibrate like fenofibrate 145mg daily may be necessary, while omega-3 fatty acids (icosapent ethyl 2g twice daily) can also be effective in reducing cardiovascular risk, as demonstrated by the REDUCE-IT trial 1.
- Statin therapy, such as atorvastatin 40-80mg daily or rosuvastatin 20-40mg daily, is crucial in reducing stroke risk and should be used as indicated to reduce the risk of cardiovascular events.
- Regular monitoring of lipid levels every 3-6 months is recommended to assess treatment efficacy, with a focus on reducing triglyceride levels and preventing recurrent stroke. The comprehensive approach should prioritize the reduction of cardiovascular risk, addressing both the elevated triglycerides and secondary stroke prevention by targeting shared risk factors and pathophysiological mechanisms, including inflammation and endothelial dysfunction, as supported by the latest guidelines 1.
From the Research
Hypertriglyceridemia Treatment with Patient History of Stroke
- Hypertriglyceridemia is a condition characterized by elevated triglyceride levels in the blood, which can increase the risk of cardiovascular disease and pancreatitis 2.
- Patients with a history of stroke, particularly those with atherothrombotic stroke, may be at higher risk of major adverse cardiovascular events due to hypertriglyceridemia 3.
- Lifestyle modifications, such as cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control, are effective ways to lower triglyceride levels 2.
- Omega-3 fatty acids, fibrates, and niacin may be used as therapeutic options to lower triglyceride levels in patients with hypertriglyceridemia 4, 5.
- Statins are the first line of therapy for managing mild to moderate hypertriglyceridemia, but additional reduction in triglyceride-rich lipoproteins and remnant particles may be necessary to further reduce residual cardiovascular risk 5.
- Hypertriglyceridemia is an important modifiable risk factor that drives residual vascular risk in patients with stroke of atherothrombotic origin, even while on statin therapy 3.
Treatment Options for Hypertriglyceridemia
- Lifestyle modifications:
- Cessation of alcohol consumption
- Reduced intake of rapidly metabolized carbohydrates
- Weight loss
- Blood sugar control
- Pharmacological treatment:
- Omega-3 fatty acids
- Fibrates
- Niacin
- Statins
Considerations for Patients with Stroke
- Patients with atherothrombotic stroke may be at higher risk of major adverse cardiovascular events due to hypertriglyceridemia 3.
- Hypertriglyceridemia may increase the risk of ischemic stroke by promoting atherosclerosis and thrombosis and increasing blood viscosity 6.
- Further studies are needed to elucidate the role of hypertriglyceridemia in the development and prognosis of ischemic stroke 6.