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. Physical exercise can be an important ancillary measure Diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus should be looked for and adequately treated.
The first line treatment for hypertriglyceridemia is dietary therapy specific for the type of lipoprotein abnormality, along with management of excess body weight and excess alcohol intake, and physical exercise as an ancillary measure.
- Key factors to address prior to drug therapy include:
- Excess body weight
- Excess alcoholic intake
- Contributory diseases such as hypothyroidism or diabetes mellitus
- Dietary therapy should be tailored to the specific type of lipoprotein abnormality. 1 2 1
From the Research
The first line treatment for hypertriglyceridemia is lifestyle modification, which includes dietary changes, weight loss, regular exercise, and alcohol limitation. This approach is supported by the most recent and highest quality study 3, which emphasizes the importance of lifestyle modifications in managing hypertriglyceridemia. Patients should reduce intake of simple carbohydrates and saturated fats while increasing consumption of omega-3 fatty acids from sources like fatty fish. A 5-10% weight reduction can significantly lower triglyceride levels. Regular aerobic exercise of at least 150 minutes per week is recommended, and alcohol intake should be minimized or eliminated.
If triglyceride levels remain elevated (>500 mg/dL) despite lifestyle changes or if the initial levels are severely elevated (>1000 mg/dL), medication therapy may be necessary. Fibrates (such as fenofibrate 145 mg daily or gemfibrozil 600 mg twice daily) are typically the first-line pharmacological treatment, followed by prescription-strength omega-3 fatty acids (2-4 g daily), and niacin (1-2 g daily) 4, 5. These interventions work by reducing triglyceride production in the liver and increasing clearance from the bloodstream, thereby lowering the risk of pancreatitis and cardiovascular disease associated with hypertriglyceridemia.
Key considerations in the management of hypertriglyceridemia include:
- Calculating a patient's 10-year risk of atherosclerotic cardiovascular disease to determine the role of medications 3
- Using statins for patients with high triglyceride levels who have borderline or intermediate risk 3
- Considering high-dose icosapent (purified eicosapentaenoic acid) for patients at high risk who continue to have high triglyceride levels despite statin use 3
- Referring patients with very rare purely genetic types of hypertriglyceridemia to specialized outpatient clinics 4
Overall, the management of hypertriglyceridemia requires a comprehensive approach that incorporates lifestyle modifications, medication therapy, and careful consideration of individual patient risk factors and needs.