From the Guidelines
Treatment for hypertriglyceridemia should prioritize lifestyle modifications, including dietary changes, weight loss, and exercise, as well as medication therapy with fibrates, omega-3 fatty acids, or statins, depending on the severity of the condition and individual patient factors, as recommended by the most recent guidelines 1.
Key Considerations
- Lifestyle changes are the first-line approach for managing hypertriglyceridemia, including reducing intake of simple carbohydrates, saturated fats, and alcohol, as well as weight loss and regular exercise 1.
- For patients with severe hypertriglyceridemia (>1000 mg/dL), immediate dietary fat restriction is crucial to prevent acute pancreatitis, and medication therapy with fibrates or omega-3 fatty acids may be necessary 1.
- Statins may be added to medication therapy, especially when LDL cholesterol is also elevated, to reduce cardiovascular risk 1.
- The choice of medication depends on triglyceride levels, other lipid abnormalities, and individual patient factors, including comorbidities and potential drug interactions 1.
Medication Options
- Fibrates, such as fenofibrate (145 mg daily) or gemfibrozil (600 mg twice daily), can reduce triglycerides by 30-50% 1.
- Omega-3 fatty acids (2-4 grams daily) are also effective in reducing triglycerides, available as prescription formulations like Lovaza or Vascepa 1.
- Statins, such as atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily), may be added to reduce cardiovascular risk, especially when LDL cholesterol is also elevated 1.
Important Considerations
- Hypertriglyceridemia increases cardiovascular disease risk and can cause pancreatitis when severely elevated 1.
- Treatment should prioritize reducing triglyceride levels, as well as addressing other cardiovascular risk factors, such as obesity, metabolic syndrome, and diabetes 1.
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. Fenofibrate tablets are indicated as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia.
Treatment for Hypertriglyceridemia:
- The initial approach is dietary therapy and lifestyle modifications, including weight loss, reduction of alcohol intake, and increased physical exercise.
- Treatment of underlying diseases such as hypothyroidism or diabetes mellitus is also crucial.
- Fenofibrate can be used as an adjunctive therapy to diet in adult patients with severe hypertriglyceridemia, with initial doses ranging from 54 mg to 160 mg per day.
- The dosage should be individualized according to patient response and adjusted if necessary following repeat lipid determinations at 4 to 8 week intervals.
- The maximum dose is 160 mg once daily 2.
From the Research
Treatment Options for Hypertriglyceridemia
The treatment for hypertriglyceridemia typically involves a combination of lifestyle changes and pharmacological interventions. Some key treatment options include:
- Lifestyle modifications, such as improved diet and increased physical activity, which are effective in lowering triglyceride levels 3, 4, 5
- Statins, which are usually the first line of therapy for managing mild to moderate hypertriglyceridemia, but may have modest effects on triglyceride reduction 3, 6
- Fibrates, which are often used in combination with statins to lower triglyceride levels, and are considered the drugs of choice for hypertriglyceridemia 3, 6
- Omega-3 fatty acids, which can be used to lower triglyceride levels, especially in patients with severely elevated triglycerides 4, 5, 6, 7
- Niacin, which can be used to improve control of triglyceride levels when other measures are inadequate 3, 6
Pharmacological Treatment
Pharmacological treatment for hypertriglyceridemia usually starts with statins, but may involve the use of other medications, such as:
- Fibrates, which can lower triglyceride concentrations, but may have limited efficacy in combination with statins 4
- Omega-3 fatty acids, which can lower triglyceride levels, and may be a well-tolerated alternative to fibrates and niacin 6, 7
- Niacin, which can improve control of triglyceride levels, but may have adverse effects and drug-drug interactions 6
Special Considerations
Certain patient populations may require special consideration, such as: