What are the implications of hypertriglyceridemia (elevated triglycerides)?

From the Guidelines

High triglycerides should be managed with lifestyle changes, including reducing sugar and refined carbohydrate intake, limiting alcohol, increasing physical activity to 30 minutes most days, and losing weight if needed, as these interventions can lower triglyceride levels and reduce the risk of heart disease 1. To lower high triglycerides, the following lifestyle changes are recommended:

• Reducing sugar and refined carbohydrate intake
• Limiting alcohol
• Increasing physical activity to at least 150 minutes per week of moderate-intensity aerobic physical activity or 75 minutes per week of vigorous-intensity aerobic physical activity 1
• Losing weight if needed, with a goal of 5% to 10% reduction in body weight, which can result in a 20% decrease in triglycerides 1 Additionally, including omega-3 rich foods like fatty fish (salmon, mackerel) in your diet twice weekly or considering fish oil supplements (1-4 grams daily) may also help lower triglyceride levels. For severely elevated levels (above 500 mg/dL), medications may be necessary, including:
• Fibrates (fenofibrate, gemfibrozil)
• Prescription omega-3s (Lovaza, Vascepa)
• Statins if you also have high cholesterol
• Niacin, although it may cause flushing Regular monitoring through blood tests is important, especially if you have diabetes, obesity, or a family history of high triglycerides, to ensure that triglyceride levels are below 150 mg/dL, and to reduce the risk of heart disease 1.

From the FDA Drug Label

Fenofibrate therapy also lowered triglycerides and raised HDL-C (see Table 4)

The effects of fenofibrate on serum triglycerides were studied in two randomized, double-blind, placebo-controlled clinical trials of 147 hypertriglyceridemic patients

Treatment with fenofibrate results in increases in high density lipoprotein (HDL) and apolipoproteins apo AI and apo AII, and reductions in total cholesterol, LDL cholesterol, apolipoprotein B, total triglycerides and triglyceride rich lipoprotein (VLDL) in treated patients.

Fenofibrate is effective in lowering triglycerides. In clinical trials, fenofibrate therapy significantly reduced triglyceride levels in patients with hypertriglyceridemia. The medication works by activating peroxisome proliferator activated receptor α (PPARα), which increases lipolysis and elimination of triglyceride-rich particles from plasma.

• Key benefits of fenofibrate in treating high triglycerides include:
  • Reductions in total triglycerides and triglyceride-rich lipoprotein (VLDL)
  • Increases in high density lipoprotein (HDL) and apolipoproteins apo AI and apo AII
  • Lowering of LDL cholesterol and apolipoprotein B 2 2

From the Research

Definition and Risks of High Triglycerides

• High triglycerides, or hypertriglyceridemia, is defined as fasting serum triglyceride levels of 150 mg per dL or higher 3
• Severely elevated triglyceride levels (500 mg per dL or higher) increase the risk of pancreatitis 3, 4, 5
• Hypertriglyceridemia is associated with increased risk of cardiovascular disease 3, 4, 5

Risk Factors for High Triglycerides

• Common risk factors for hypertriglyceridemia include obesity, metabolic syndrome, and type 2 diabetes mellitus 3
• Less common risk factors include excessive alcohol use, physical inactivity, being overweight, use of certain medications, and genetic disorders 3

Management of High Triglycerides

• Management of high triglyceride levels starts with dietary changes and physical activity to lower cardiovascular risk 3
• Lowering carbohydrate intake (especially refined carbohydrates) and increasing fat (especially omega-3 fatty acids) and protein intake can lower triglyceride levels 3
• Moderate- to high-intensity physical activity can lower triglyceride levels, as well as improve body composition and exercise capacity 3
• Statins can be considered for patients with high triglyceride levels who have borderline (5% to 7.4%) or intermediate (7.5% to 19.9%) risk 3
• Fibrates, omega-3 fatty acids, or niacin should be considered for patients with severely elevated triglyceride levels to reduce the risk of pancreatitis 3, 4, 5

Treatment Options

• Omega-3 fatty acids and fenofibrate are both used to treat patients with hypertriglyceridemia, with fenofibrate having substantially better effects on lipoprotein and metabolic profiles 6
• Concomitant use of prescription omega-3 fatty acids and fenofibrate can result in a greater reduction in triglyceride levels than fenofibrate alone 7
• Addition of prescription omega-3 fatty acids to stable fenofibrate therapy can result in a statistically significant reduction in triglyceride levels 7