What medication is appropriate for treating hypertriglyceridemia?

From the Guidelines

Fibrates are the first-line treatment for patients with hypertriglyceridemia who are at risk of pancreatitis, and should be considered in combination with other medications such as niacin and n-3 fatty acids for moderate to severe hypertriglyceridemia. When considering medication for high triglycerides, it's essential to evaluate the patient's overall cardiovascular risk profile and other lipid abnormalities 1. For patients with mild to moderate hypertriglyceridemia, lifestyle modifications such as dietary counseling, weight loss, and increased physical activity should be the initial approach. However, for those with severe to very severe hypertriglyceridemia, medication is often necessary to reduce the risk of pancreatitis. Some key considerations for medication selection include:

• Triglyceride levels: Fibrates such as fenofibrate are often recommended for severe hypertriglyceridemia (≥500 mg/dL) to reduce the risk of pancreatitis 1.
• Other lipid abnormalities: Statins may be useful for modifying cardiovascular risk in patients with moderately elevated triglyceride levels, but should not be used alone in patients with severe or very severe hypertriglyceridemia 1.
• Comorbidities: Patients with central obesity, hypertension, abnormal glucose metabolism, and liver dysfunction should be assessed for other cardiovascular risk factors 1.
• Cardiovascular risk profile: The choice of medication depends on the patient's overall cardiovascular risk profile, and medications such as prescription-strength omega-3 fatty acids and niacin may be effective either alone or in combination with other medications 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.

Fenofibrate is appropriate for treating hypertriglyceridemia. The medication is indicated for use in adult patients with severe hypertriglyceridemia as an adjunct to diet. Key benefits of fenofibrate include:

• Reduction of triglycerides
• Increase of HDL-C
• Reduction of LDL-C and Total-C 2 and 2 support the use of fenofibrate for this purpose.

From the Research

Medication Options for Hypertriglyceridemia

Medications used to treat hypertriglyceridemia include:

• Fibrates: Fenofibrate is a commonly used fibrate that has been shown to reduce triglyceride levels by 50-60% in patients with high triglyceride levels 3, 4, 5
• Omega-3 fatty acids: Long-chain omega-3 fatty acids, such as those found in prescription omega-3 fatty acid supplements, have been shown to reduce triglyceride levels by 30-50% in patients with hypertriglyceridemia 6, 4
• Niacin: Niacin, or nicotinic acid, is another medication that can be used to treat hypertriglyceridemia, although it is not as commonly used as fibrates or omega-3 fatty acids due to its side effect profile 6
• Statins: While statins are primarily used to lower low-density lipoprotein (LDL) cholesterol, they can also reduce triglyceride levels by up to 18% in patients with mild to moderate hypertriglyceridemia 6

Factors Associated with Triglyceride Reduction

Several factors have been associated with triglyceride reduction in patients treated with fibrates, including:

• Female sex: Women may be more likely to achieve triglyceride levels <150 mg/dL with fenofibrate therapy than men 3
• Non-diabetic status: Patients without diabetes may be more likely to achieve triglyceride levels <150 mg/dL with fenofibrate therapy than those with diabetes 3
• Coronary artery disease: Patients with coronary artery disease may be more likely to achieve triglyceride levels <150 mg/dL with fenofibrate therapy than those without coronary artery disease 3
• Lower baseline triglyceride levels: Patients with lower baseline triglyceride levels may be more likely to achieve triglyceride levels <150 mg/dL with fenofibrate therapy than those with higher baseline triglyceride levels 3

Combination Therapy

Combination therapy with fibrates and omega-3 fatty acids may be more effective than monotherapy with either agent alone in reducing triglyceride levels in patients with hypertriglyceridemia 4 Combination therapy with fenofibrate and prescription omega-3 fatty acids has been shown to reduce triglyceride levels by 60% in patients with very high triglyceride levels 4