From the Guidelines
High triglyceride levels are a significant risk factor for heart disease and other cardiovascular problems, and managing them is crucial to reduce the risk of morbidity, mortality, and improve quality of life. Elevated triglycerides (above 150 mg/dL) contribute to atherosclerosis, the buildup of fatty deposits in artery walls that can restrict blood flow to the heart and brain. This condition often occurs alongside other lipid abnormalities like low HDL ("good") cholesterol and small, dense LDL particles, creating a dangerous combination that accelerates plaque formation. High triglycerides are particularly concerning when they exceed 500 mg/dL, as this level raises the risk of acute pancreatitis. The relationship between triglycerides and heart disease involves several mechanisms, including increased inflammation, endothelial dysfunction, and enhanced blood clotting potential, as noted in studies such as 1 and 1.
Key Points to Consider
- The Endocrine Society defines hypertriglyceridemia as follows: mild (150-199 mg/dL), moderate (200-999 mg/dL), severe (1,000-1,999 mg/dL), and very severe (≥2,000 mg/dL) 1.
- Contributing factors to elevated triglyceride levels include overweight and obesity, physical inactivity, excessive alcohol intake, metabolic syndrome, type 2 diabetes mellitus, and certain genetic disorders 1.
- Treatment typically begins with lifestyle modifications such as reducing refined carbohydrates and sugars, limiting alcohol, increasing physical activity, and achieving healthy weight.
- When lifestyle changes aren't sufficient, medications may be prescribed, including fibrates (like fenofibrate 145mg daily), omega-3 fatty acids (2-4g daily), statins, or niacin, as recommended by guidelines such as those from the Endocrine Society 1 and the American Heart Association 1.
Management and Treatment
The primary goal in managing high triglyceride levels is to reduce the risk of cardiovascular disease and pancreatitis, which can be achieved through a combination of lifestyle modifications and, when necessary, medication. Regular lipid panel testing is essential for monitoring triglyceride levels and adjusting treatment as needed. It's also important to evaluate patients for secondary causes of hyperlipidemia and treat them accordingly, considering factors such as excessive alcohol intake, untreated diabetes, and certain medications that can elevate triglyceride levels 1.
From the FDA Drug Label
The effect of fenofibrate on cardiovascular morbidity and mortality has not been determined.
The FDA drug label does not answer the question.
From the Research
Impact of High Triglyceride Levels on Cardiac Health
- High triglyceride levels are associated with an increased risk of cardiovascular disease, even after adjustment for low-density lipoprotein cholesterol (LDL-C) levels 2, 3.
- Elevated triglyceride levels can alter lipoprotein metabolism, increasing the risk of cardiovascular disease 3.
- Hypertriglyceridemia is a major cardiovascular risk factor, and its significance as a therapeutic target was previously underestimated 4.
- The existence of an independent association between elevated triglyceride levels, cardiovascular risk, and mortality has been established 4.
Effects of High Triglyceride Levels on Cardiac Health
- High triglyceride levels can lead to a reduction in high-density lipoprotein (HDL) and an increase in atherogenic small dense LDL levels 4.
- Triglycerides may stimulate atherogenesis by mechanisms such as excessive free fatty acids release, production of proinflammatory cytokines, fibrinogen, coagulation factors, and impairment of fibrinolysis 4.
- Genetic studies strongly support hypertriglyceridemia and high concentrations of triglyceride-carrying lipoproteins as causal risk factors for cardiovascular disease 4.
Treatment of High Triglyceride Levels
- Intensive lifestyle therapy is the main initial treatment of hypertriglyceridemia 4.
- Statins are a cornerstone of modern lipids-modifying therapy, but fibrates, niacin, or long-chain omega-3 fatty acids may be added if elevated triglyceride or non-high-density lipoprotein cholesterol levels persist despite statin therapy 2, 5.
- Omega-3 fatty acids and fenofibrate are both used to treat patients with hypertriglyceridemia, but they have different effects on lipoprotein and metabolic profiles 6.
- 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.