From the Guidelines
The treatment for hypertriglyceridemia involves lifestyle modifications as the first-line approach, including a low-fat diet, weight loss if overweight, regular exercise, limiting alcohol consumption, and avoiding refined carbohydrates and sugars, as recommended by the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1.
Key Lifestyle Modifications:
- Low-fat diet (less than 30% of calories from fat)
- Weight loss if overweight
- Regular exercise
- Limiting alcohol consumption
- Avoiding refined carbohydrates and sugars
Medications for Hypertriglyceridemia:
For patients with triglyceride levels above 500 mg/dL, medications are typically recommended to reduce the risk of pancreatitis.
- Fibrates such as fenofibrate (145 mg daily) or gemfibrozil (600 mg twice daily) can lower triglycerides by 30-50%
- Omega-3 fatty acids (2-4 grams daily) are also effective and can be used alone or in combination with other medications
- For patients with very high levels, prescription-strength omega-3s like icosapent ethyl (Vascepa, 2 grams twice daily) or omega-3 acid ethyl esters (Lovaza, 4 grams daily) may be used
- Statins like atorvastatin or rosuvastatin can be added when LDL cholesterol is also elevated, as supported by the 2025 standards of care in diabetes 1
Monitoring Treatment Effectiveness:
Treatment effectiveness should be monitored with lipid panels every 4-12 weeks initially, then every 3-12 months once stable, as suggested by various guidelines including the 2022 standards of medical care in diabetes 1. These medications work by reducing triglyceride production in the liver and enhancing clearance from the bloodstream, thereby lowering the risk of cardiovascular disease and pancreatitis associated with hypertriglyceridemia.
From the FDA Drug Label
The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy. Fenofibrate tablets are indicated as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia.
The treatment for high triglycerides (hypertriglyceridemia) involves:
- Dietary therapy: The initial treatment is dietary therapy specific for the type of lipoprotein abnormality.
- Lifestyle changes: Addressing excess body weight and excess alcoholic intake, which may be important factors in hypertriglyceridemia.
- Fenofibrate tablets: As adjunctive therapy to diet for the treatment of adult patients with severe hypertriglyceridemia.
- Initial dose: 54 mg per day to 160 mg per day, with dosage individualized according to patient response and adjusted if necessary following repeat lipid determinations at 4 to 8 week intervals.
- Maximum dose: 160 mg once daily 2.
From the Research
Treatment Options for Hypertriglyceridemia
The treatment for hypertriglyceridemia typically involves a combination of lifestyle modifications and medication.
- Lifestyle modifications include:
- Cessation of alcohol consumption
- Reduced intake of rapidly metabolized carbohydrates
- Weight loss
- Blood sugar control
- Dietary changes, such as lowering carbohydrate intake and increasing fat and protein intake
- Moderate- to high-intensity physical activity As stated in the study 3, lifestyle modifications are the most effective ways to lower triglyceride levels.
Medication Options
Medications may be necessary for patients with severely elevated triglyceride levels or those who do not respond to lifestyle modifications.
- Medication options include:
- Fibrates, which can lower triglyceride concentrations
- Omega-3 fatty acids, which can lower triglyceride levels
- Statins, which can be considered for patients with high triglyceride levels who have borderline or intermediate risk of cardiovascular disease
- Niacin, which can be considered for patients with severely elevated triglyceride levels As noted in the study 4, high-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality in patients at high risk.
Specific Treatment Approaches
For patients with acute pancreatitis associated with hypertriglyceridemia, insulin infusion and plasmapheresis should be considered if triglyceride levels remain high despite conservative management 4. For patients with very high triglyceride levels, concomitant use of prescription omega-3 fatty acids and fenofibrate may result in a greater reduction in triglyceride levels than fenofibrate alone 5. Fenofibrate therapy has been shown to have substantially better effects on lipoprotein and metabolic profiles in patients with hypertriglyceridemia compared to omega-3 fatty acids 6.
Specialized Treatment
Patients with purely genetic types of hypertriglyceridemia, such as familial chylomicronemia syndrome, should be treated in specialized outpatient clinics 3.