What medications are used to lower elevated triglyceride (hypertriglyceridemia) levels?

From the Guidelines

For patients with hypertriglyceridemia, fibrates, such as fenofibrate, or prescription-strength omega-3 fatty acids, like icosapent ethyl, are recommended as first-line treatments, especially for those with severely elevated triglycerides (≥500 mg/dL) or at risk of pancreatitis, as stated in the most recent guidelines 1. When considering treatment options for hypertriglyceridemia, it's essential to evaluate the patient's overall cardiovascular risk and address lifestyle factors, secondary causes, and medications that may contribute to elevated triglyceride levels 1.

• Key considerations include:
  • Evaluating for secondary causes of hypertriglyceridemia and considering medical therapy to reduce the risk of pancreatitis in individuals with fasting triglyceride levels ≥500 mg/dL 1
  • Addressing and treating lifestyle factors, secondary factors, and medications that raise triglycerides in adults with hypertriglyceridemia 1
  • Considering the addition of icosapent ethyl to reduce cardiovascular risk in individuals with ASCVD or other cardiovascular risk factors on a statin with managed LDL cholesterol but elevated triglycerides (150–499 mg/dL) 1 Treatment should be accompanied by lifestyle modifications, including reducing sugar and refined carbohydrate intake, limiting alcohol, increasing physical activity, and losing weight if needed, as well as regular monitoring of blood levels to assess effectiveness and adjust dosing as necessary 1.

From the FDA Drug Label

Atorvastatin calcium reduces total-C, LDL-C, apo B, and TG, and increases HDL-C in patients with hyperlipidemia (heterozygous familial and nonfamilial) and mixed dyslipidemia The response to atorvastatin calcium in 64 patients with isolated hypertriglyceridemia treated across several clinical trials is shown in the table below (Table 10). For the atorvastatin calcium-treated patients, median (min, max) baseline TG level was 565 (267 to 1,502) Table 10: Combined Patients With Isolated Elevated TG: Median (min, max) Percentage Change From Baseline Atorvastatin 10 mg (N=37) TG -41 (-76.2,49.4) Atorvastatin 20 mg (N=13) TG -38.7 (-62.7,29.5) Atorvastatin 80 mg (N=14) TG -51.8 (-82.8,41.3)

Atorvastatin can be used to lower triglyceride levels. The medication has been shown to significantly reduce TG levels in patients with hypertriglyceridemia.

• The median percentage change from baseline TG level was -41% for patients treated with atorvastatin 10 mg.
• The median percentage change from baseline TG level was -38.7% for patients treated with atorvastatin 20 mg.
• The median percentage change from baseline TG level was -51.8% for patients treated with atorvastatin 80 mg 2.

From the Research

Medications for Lowering Triglyceride Levels

• 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 of atherosclerotic cardiovascular disease 3
• Fibrates are the best-established agents for triglyceride level lowering and are generally used as first-line treatment of triglyceride levels greater than 500 mg/dL 4
• High-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality in patients at high risk who continue to have high triglyceride levels despite statin use 3
• Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can decrease hepatic de novo lipogenesis and partition fatty acids away from triacylglycerol synthesis and toward β-oxidation, resulting in decreased accumulation of hepatic triglycerides and lowering of circulating triglyceride concentrations 5, 6
• Fenofibrate can significantly reduce triglyceride, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol levels, and also reduce C-reactive protein levels 7

Treatment Considerations

• For patients with severely elevated triglyceride levels, fibrates, omega-3 fatty acids, or niacin should be considered to reduce the risk of pancreatitis 3
• For patients with acute pancreatitis associated with hypertriglyceridemia, insulin infusion and plasmapheresis should be considered if triglyceride levels remain at 1,000 mg per dL or higher despite conservative management of acute pancreatitis 3
• The choice of medication should be based on the patient's individual risk factors and medical history, as well as the severity of their hypertriglyceridemia 3, 4