What is the treatment for hypertriglyceridemia (elevated triglycerides) in a 52-year-old non-diabetic female with hypertriglyceridemia (triglycerides 305.6 mg/dL)?

From the Guidelines

For a 52-year-old non-diabetic female with hypertriglyceridemia of 305.6 mg/dL, I strongly recommend initiating lifestyle modifications and considering medication therapy to reduce the risk of cardiovascular disease and pancreatitis. The patient's hypertriglyceridemia level is considered moderate to severe, and according to the guidelines from the Endocrine Society 1, the initial treatment should include dietary counseling and weight loss in patients who are overweight or obese.

Lifestyle Modifications

• Reducing simple carbohydrates and saturated fats
• Increasing omega-3 rich foods like fatty fish
• Aim for weight loss of 5-10% if overweight
• Incorporate 150 minutes of moderate-intensity exercise weekly
• Completely avoid alcohol These lifestyle modifications should be maintained for at least 3 months before reassessing triglyceride levels.

Medication Therapy

If levels remain above 200 mg/dL despite lifestyle modifications, consider starting a fibrate such as fenofibrate 145 mg daily or gemfibrozil 600 mg twice daily, as recommended by the American Heart Association and the American College of Cardiology 1.

• Alternatively, prescription omega-3 fatty acids (icosapent ethyl 2 grams twice daily or omega-3 ethyl esters 2 grams twice daily) may be prescribed.
• Statins are generally not first-line for isolated hypertriglyceridemia but may be considered if LDL cholesterol is also elevated, as suggested by the Diabetes Care guidelines 1. Regular monitoring every 3-6 months is recommended to assess treatment efficacy and adjust therapy as needed. The goal of treatment is to reduce the risk of cardiovascular disease and pancreatitis, and to achieve a non–high-density lipoprotein cholesterol level of 30 mg per dL (0.78 mmol per L) higher than the low-density lipoprotein goal, as recommended by the NCEP ATP III 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. Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy.

The patient has hypertriglyceridemia with a level of 305.6 mg/dL. Given that fenofibrate is indicated for the treatment of severe hypertriglyceridemia, and the patient's level is not considered severely elevated (> 2,000 mg/dL), the initial dose of 54 mg per day to 160 mg per day can be considered.

• The patient should be placed on an appropriate lipid-lowering diet before receiving fenofibrate tablets and should continue this diet during treatment.
• Excess body weight and excess alcoholic intake should be addressed prior to any drug therapy.
• The dosage should be individualized according to patient response and adjusted if necessary following repeat lipid determinations at 4 to 8 week intervals 2.

From the Research

Treatment Options for Hypertriglyceridemia

The patient's triglyceride level is 305.6 mg/dL, which is considered hypertriglyceridemia. According to the studies, the following treatment options are available:

• Dietary changes and physical activity to lower cardiovascular risk 3
• Omega-3 fatty acids, which can reduce triglyceride levels by 21-45% 4, 5, 6
• Fibrates, such as fenofibrate, which can decrease triglycerides by 29% and improve lipoprotein and metabolic profiles 7, 6
• Niacin, which can be used to reduce triglyceride levels, but its use is limited due to adverse effects 7

Omega-3 Fatty Acids as a Treatment Option

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown to be effective in reducing triglyceride levels. The recommended dose is 2-4 g/day of EPA and DHA 4, 5. Prescription omega-3 fatty acids have been approved by the US Food and Drug Administration for the treatment of very high triglyceride levels 4.

Comparison of Treatment Options

A study compared the effects of omega-3 fatty acids and fenofibrate in patients with hypertriglyceridemia. The results showed that both treatments reduced triglyceride levels, but fenofibrate had better effects on lipoprotein and metabolic profiles 6. Another study found that omega-3 fatty acids and fibrates can be used as an adjunct to statin therapy to further reduce triglyceride levels and cardiovascular risk 7.

Considerations for the Patient

The patient's triglyceride level is 305.6 mg/dL, which is not severely elevated. However, the patient's age and non-diabetic status should be taken into consideration when selecting a treatment option. According to the studies, omega-3 fatty acids and fibrates can be effective in reducing triglyceride levels and improving cardiovascular risk factors 4, 3, 5, 7, 6.