From the Guidelines
Hypertriglyceridemia should be managed with lifestyle modifications as the first line of therapy, including a low-fat diet, regular exercise, weight loss if overweight, limiting alcohol consumption, and avoiding refined carbohydrates and sugary foods, as recommended by the 2021 ACC expert consensus decision pathway 1.
Key Recommendations
- Lifestyle interventions are the foundation of treatment for hypertriglyceridemia, with a focus on weight loss, dietary changes, and increased physical activity 1.
- For patients with triglyceride levels above 500 mg/dL, medication may be necessary, with options including fibrates, omega-3 fatty acids, and statins 1.
- Severe hypertriglyceridemia (levels above 1000 mg/dL) requires a more rigorous approach, with a very low-fat diet (10-15% of calories from fat) and consideration of combination therapy 1.
Lifestyle Modifications
- Weight loss is a crucial component of hypertriglyceridemia management, with a goal of reducing body weight by 5-10% to achieve a 20% decrease in triglycerides 1.
- Regular exercise, such as at least 150 minutes of moderate activity weekly, is also essential for improving triglyceride levels and overall cardiovascular health 1.
- Dietary changes should focus on reducing fat intake, avoiding refined carbohydrates and sugary foods, and increasing consumption of fruits, vegetables, and whole grains 1.
Pharmacological Treatment
- Fibrates, such as fenofibrate (145 mg daily) or gemfibrozil (600 mg twice daily), are a first-line treatment option for hypertriglyceridemia, particularly for patients with triglyceride levels above 500 mg/dL 1.
- Omega-3 fatty acids (2-4 grams daily) and statins, such as atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily), may also be considered for patients with hypertriglyceridemia, especially those with elevated cardiovascular risk 1.
Monitoring and Follow-up
- Triglyceride levels should be monitored regularly, typically every 3-6 months until stable, then annually, to assess the effectiveness of treatment and adjust therapy as needed 1.
- Hypertriglyceridemia often occurs alongside other metabolic conditions, such as diabetes or metabolic syndrome, so managing these underlying conditions is crucial for comprehensive treatment and reducing cardiovascular risk 1.
From the FDA Drug Label
The effects of fenofibrate on serum triglycerides were studied in two randomized, double-blind, placebo-controlled clinical trials of 147 hypertriglyceridemic patients Fenofibrate therapy lowered triglycerides and raised HDL-C (see Table 4) Treatment of patients with elevated triglycerides often results in an increase of LDL-C (see Table 5) Fenofibrate also reduces serum uric acid levels in hyperuricemic and normal individuals by increasing the urinary excretion of uric acid. Fenofibric acid, the active metabolite of fenofibrate, produces reductions in total cholesterol, LDL cholesterol, apolipoprotein B, total triglycerides and triglyceride rich lipoprotein (VLDL) in treated patients.
Fenofibrate is used to treat hypertriglyceridemia.
- It lowers triglycerides and raises HDL-C.
- The effect of fenofibrate on cardiovascular morbidity and mortality has not been determined.
- Key benefits of fenofibrate include:
- Reductions in total cholesterol, LDL cholesterol, apolipoprotein B, total triglycerides, and triglyceride rich lipoprotein (VLDL).
- Increases in high density lipoprotein (HDL) and apolipoproteins apo AI and apo AII. 2
From the Research
Definition and Prevalence of Hypertriglyceridemia
- Hypertriglyceridemia is defined as fasting serum triglyceride levels of 150 mg per dL or higher 3
- It affects approximately 33% of the US population 4 and 15-20% of the adult population 5
Risk Factors and Associated Conditions
- Common risk factors for hypertriglyceridemia include obesity, metabolic syndrome, and type 2 diabetes mellitus 3, 6
- Less common risk factors include excessive alcohol use, physical inactivity, being overweight, use of certain medications, and genetic disorders 3
- Hypertriglyceridemia is associated with increased risk of cardiovascular disease and pancreatitis 5, 3, 4
Management and Treatment
- Lifestyle modifications, such as dietary changes and physical activity, play a paramount role in the treatment of hypertriglyceridemia 5, 3, 6
- Lowering carbohydrate intake and increasing fat and protein intake can lower triglyceride levels 3
- Statins can be considered for patients with high triglyceride levels who have borderline or intermediate risk of atherosclerotic cardiovascular disease 3
- Fibrates, omega-3 fatty acids, or niacin can be considered for patients with severely elevated triglyceride levels to reduce the risk of pancreatitis 3, 4
- Long-chain omega-3 fatty acids may be a well-tolerated and effective alternative to fibrates and niacin 4, 7
Medications and Their Effects
- Omega-3 fatty acids therapy can decrease triglycerides by 21% and improve flow-mediated dilation 7
- Fenofibrate therapy can decrease total cholesterol, triglycerides by 29%, and triglycerides/HDL-cholesterol, and improve flow-mediated dilation 7
- Fenofibrate therapy has substantially better effects on lipoprotein and metabolic profiles in patients with hypertriglyceridemia compared to omega-3 fatty acids 7