From the Guidelines
The treatment for elevated triglycerides should prioritize lifestyle modifications, including weight loss, regular exercise, and a low-carbohydrate diet with reduced saturated fats, alongside consideration of medications such as statins, fibrates, or omega-3 fatty acids, depending on the severity of hypertriglyceridemia and the presence of other cardiovascular risk factors, as recommended by the most recent guidelines 1.
Severity-Based Approach
The approach to treating elevated triglycerides depends on the severity of the condition:
- For mild to moderate hypertriglyceridemia (150-499 mg/dL), lifestyle changes are often sufficient.
- For levels above 500 mg/dL, medications are usually necessary alongside lifestyle changes.
- For very severe hypertriglyceridemia (>1000 mg/dL), combination therapy may be necessary to reduce the risk of acute pancreatitis.
Medication Options
First-line medications include:
- Statins like atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily), which can lower triglycerides by 20-40% 1.
- Fibrates such as fenofibrate (48-145 mg daily) or gemfibrozil (600 mg twice daily) are effective for more severe cases, reducing levels by 30-50% 1.
- Omega-3 fatty acids (2-4 grams daily) are also beneficial, either as prescription formulations like Vascepa or Lovaza, or as high-quality supplements 1.
Importance of Treatment
Treatment is crucial because elevated triglycerides increase cardiovascular disease risk and levels above 1000 mg/dL can cause acute pancreatitis. Regular monitoring is essential to assess treatment effectiveness and adjust therapy as needed 1.
Key Considerations
- Patients with severe hypertriglyceridemia should be evaluated for secondary causes of hypertriglyceridemia and considered for medical therapy to reduce the risk of pancreatitis 1.
- Lifestyle interventions, including Medical Nutrition Therapy (MNT), are important for all patients with elevated triglycerides, with a more rigorous approach advised for patients with triglycerides ≥1000 mg/dL 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 elevated triglycerides (hypertriglyceridemia) is fenofibrate as an adjunct to diet.
- The initial dose of fenofibrate tablet is 160 mg once daily for primary hypercholesterolemia or mixed dyslipidemia.
- The initial dose for severe hypertriglyceridemia is 54 mg per day to 160 mg per day.
- Dietary therapy is the initial treatment for dyslipidemia and should be continued during treatment with fenofibrate.
- Patients should be advised to follow an appropriate lipid-modifying diet while taking fenofibrate tablets 2.
From the Research
Treatment for Elevated Triglycerides
The treatment for elevated triglycerides, also known as hypertriglyceridemia, involves a combination of lifestyle modifications and medication.
- Lifestyle modifications are the most effective way to lower triglyceride levels, including:
- Cessation of alcohol consumption
- Reduced intake of rapidly metabolized carbohydrates
- Weight loss
- Blood sugar control
- Medications may be necessary for some patients, including:
- Fibrates, which can lower triglyceride concentrations
- Omega-3 fatty acids, which can also lower triglyceride levels
- Statins, which can lower low-density lipoprotein (LDL) concentration and reduce the risk of cardiovascular disease
Medication Options
- Fibrates, such as fenofibrate, can be effective in reducing triglyceride levels, but their efficacy in combination with statins has not been clearly shown in endpoint studies 3, 4.
- Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can lower triglyceride levels and may be used as an adjunct to fenofibrate therapy 4, 5.
- Statins are the first-line therapy for reducing the risk of cardiovascular disease in patients with elevated triglycerides, and may be used in combination with other medications to achieve optimal lipid levels 6, 5, 7.
Special Considerations
- Patients with severely elevated triglyceride levels (≥500 mg/dL) are at increased risk of pancreatitis and may require immediate treatment with triglyceride-lowering agents 6, 5.
- Patients with familial chylomicronemia syndrome, a rare genetic disorder characterized by very high triglyceride levels, should be treated in specialized outpatient clinics 3.
- The use of icosapent ethyl esters, a purified EPA, has been shown to reduce cardiovascular risk in patients with elevated triglycerides and may be used in patients with residual hypertriglyceridemia on maximally tolerated statin therapy 7.