What is the treatment for hypertriglyceridemia?

From the Guidelines

The treatment for hypertriglyceridemia should prioritize lifestyle modifications, including dietary changes, weight loss, and regular exercise, as the first line of therapy, as recommended by the 2021 ACC expert consensus decision pathway 1.

Key Components of Treatment

• Lifestyle interventions are the foundation of management for patients with hypertriglyceridemia, aiming to reduce triglyceride levels and overall cardiovascular risk.
• Dietary counseling and weight loss are crucial for patients who are overweight or obese, with a focus on reducing intake of simple carbohydrates, saturated fats, and alcohol.
• Increasing consumption of omega-3 fatty acids from fish or supplements is also beneficial.
• For patients with severe hypertriglyceridemia, reduced intake of dietary fat and simple carbohydrates is recommended, in combination with drug treatment to reduce the risk of pancreatitis.

Medications

• First-line pharmacotherapy includes fibrates, omega-3 fatty acids, and statins, which work through various mechanisms to lower triglyceride levels.
• Fibrates, such as fenofibrate, activate peroxisome proliferator-activated receptors, enhancing triglyceride clearance.
• Statins, such as atorvastatin, primarily reduce cholesterol synthesis but also moderately lower triglycerides.
• Omega-3 fatty acids decrease hepatic triglyceride production.

Monitoring and Adjustment

• Regular monitoring of lipid levels is essential to assess treatment efficacy and adjust therapy as needed.
• Combination therapy may be necessary for severe hypertriglyceridemia, and medications should be selected based on the patient's individual risk factors and medical history, as guided by the most recent recommendations from the American College of Cardiology 1 and the standards of care in diabetes-2025 1.

From the FDA Drug Label

Fenofibrate tablets are indicated as adjunctive therapy to diet to reduce elevated low-density lipoprotein cholesterol (LDL-C), total cholesterol (Total-C), Triglycerides and apolipoprotein B (Apo B), and to increase high-density lipoprotein cholesterol (HDL-C) in adult patients with primary hypercholesterolemia or mixed dyslipidemia. Fenofibrate tablets are also indicated as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia.

The treatment for hypertriglyceridemia is:

• Dietary therapy: The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality.
• Fenofibrate tablets: As adjunctive therapy to diet, to reduce elevated triglycerides in adult patients with severe hypertriglyceridemia.
• Dosage: The initial dose is 54 mg per day to 160 mg per day, with a maximum dose of 160 mg once daily.
• Lifestyle modifications: Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy. Physical exercise can be an important ancillary measure. 2

From the Research

Treatment Options for Hypertriglyceridemia

The treatment for hypertriglyceridemia involves a combination of lifestyle modifications and pharmacological interventions.

• Lifestyle modifications, such as cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control, are the most effective ways to lower triglyceride (TG) levels 3.
• Dietary changes, including lowering carbohydrate intake and increasing fat and protein intake, can also help lower triglyceride levels 4.
• Moderate- to high-intensity physical activity can lower triglyceride levels and improve body composition and exercise capacity 4.

Pharmacological Interventions

• Statins can be considered for patients with high triglyceride levels who have borderline or intermediate risk of atherosclerotic cardiovascular disease 4.
• Fibrates can lower TG concentrations, but their efficacy in combination with statins has not been clearly shown in endpoint studies 3, 5.
• Omega-3 fatty acids, particularly eicosapentaenoic acid ethyl ester, can lower TG levels and reduce cardiovascular risk in high-risk patients 3, 4, 6.
• Niacin can also improve control of triglyceride levels when other measures are inadequately effective 5, 6.

Specialized Treatment

• Patients with severely elevated triglyceride levels (≥500 mg/dL) may require immediate use of triglyceride-lowering agents to reduce the risk of pancreatitis 4, 6.
• Patients with acute pancreatitis associated with hypertriglyceridemia may require insulin infusion and plasmapheresis if triglyceride levels remain high despite conservative management 4.
• Patients with purely genetic types of hypertriglyceridemia, such as familial chylomicronemia syndrome, should be treated in specialized outpatient clinics 3.