From the Guidelines
The treatment for hypertriglyceridemia involves both lifestyle modifications and medications, with lifestyle changes being the first-line approach, including weight loss, regular exercise, limiting alcohol consumption, and following a low-fat diet with reduced simple carbohydrates. For medication therapy, statins are often used first, particularly for moderate elevations (150-499 mg/dL) 1. For higher triglyceride levels (≥500 mg/dL), fibrates like fenofibrate or gemfibrozil are recommended, as well as omega-3 fatty acids (2-4 g daily) available as prescription formulations like Lovaza or Vascepa 1. Niacin (1-2 g daily) can reduce triglycerides but has more side effects including flushing. For severe hypertriglyceridemia (>1000 mg/dL), immediate fat restriction is crucial to prevent pancreatitis, and pharmacologic therapy (fibrin acid derivatives and/or fish oil) may be warranted 1.
Some key points to consider in the treatment of hypertriglyceridemia include:
- Evaluating for secondary causes of hypertriglyceridemia and considering medical therapy to reduce the risk of pancreatitis in patients with fasting triglyceride levels ≥500 mg/dL 1
- Addressing and treating lifestyle factors, secondary factors, and medications that raise triglycerides in adults with hypertriglyceridemia 1
- Considering the addition of icosapent ethyl to reduce cardiovascular risk in individuals with ASCVD or other cardiovascular risk factors on a statin with managed LDL cholesterol but elevated triglycerides (150–499 mg/dL) 1
- Using moderate- or high-intensity statin therapy as indicated to reduce the risk of cardiovascular events 1
Overall, the goal of treatment is to reduce the risk of cardiovascular disease and acute pancreatitis, and to improve the patient's quality of life. The choice of medication depends on triglyceride levels, other lipid abnormalities, and individual patient factors.
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.
- The need to lower low-density lipoprotein (LDL) concentration must be determined on the basis of cardiovascular risk, independently of the success of lifestyle changes 3.
Pharmacological Interventions
Pharmacological interventions may be necessary for some patients, including:
- Fibrates, which can lower TG concentrations, but their efficacy in combination with statins has not been clearly shown in endpoint studies 3, 4.
- Omega-3 fatty acids, which can lower TG levels, with a daily dose of 2-4 g being effective 3, 5, 6.
- Statins, which are the first-line treatment for managing mild to moderate hypertriglyceridemia, and can reduce TG levels by up to 18% 5, 7.
- Niacin, which is also useful for patients with hypertriglyceridemia, but may have adverse effects and drug-drug interactions 4, 5.
- Icosapent ethyl, which may be added to background statin therapy to further reduce atherosclerotic cardiovascular disease risk in patients with moderate hypertriglyceridemia 7.
Specialized Treatment
Patients with severe hypertriglyceridemia (TG levels ≥ 500 mg/dL) may require hospitalization and treatment with hypolipidemic drugs, insulin/dextrose infusion, or therapeutic apheresis 4.