From the Guidelines
To lower hypertriglyceridemia, focus on lifestyle modifications and medications when necessary, with the goal of bringing triglycerides below 150 mg/dL to reduce cardiovascular risk and prevent pancreatitis. The most effective approach to managing hypertriglyceridemia involves a combination of dietary changes, increased physical activity, and weight loss, as supported by the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1. Key lifestyle interventions include:
- Reducing intake of simple carbohydrates and sugars
- Limiting alcohol consumption
- Increasing physical activity to at least 150 minutes of moderate exercise weekly
- Adopting a Mediterranean-style diet rich in omega-3 fatty acids from fish, nuts, and olive oil
- Reducing processed foods and trans fats Weight loss of 5-10% can significantly reduce triglyceride levels, with a dose-response relationship between the amount of weight lost and triglyceride lowering 1. For medication options, fibrates like fenofibrate (145mg daily) or gemfibrozil (600mg twice daily) are first-line treatments for severe hypertriglyceridemia (>500 mg/dL), as recommended by the Endocrine Society guidelines on diagnosis and management of hypertriglyceridemia 1. Omega-3 fatty acid supplements (2-4g daily) can be effective, while statins may be added if LDL cholesterol is also elevated 1. Niacin (1-2g daily) can lower triglycerides but has more side effects. Regular monitoring of lipid levels is important to assess treatment effectiveness. It's also important to assess patients for other cardiovascular risk factors, such as central obesity, hypertension, abnormal glucose metabolism, and liver dysfunction 1. Overall, a comprehensive approach that incorporates lifestyle modifications and medications can help reduce triglyceride levels and improve cardiovascular health.
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 Omega-3-acid ethyl esters 4 grams per day reduced median TG, VLDL-C, and non-HDL-C levels and increased median HDL-C from baseline relative to placebo.
To lower hypertriglyceridemia, the following steps can be taken:
- Dietary therapy: Follow a lipid-lowering diet specific for the type of lipoprotein abnormality.
- Address excess body weight and alcoholic intake: These factors can contribute to hypertriglyceridemia and should be addressed before starting drug therapy.
- Physical exercise: Regular exercise can be an important ancillary measure to help lower triglycerides.
- Medications:
- Omega-3-acid ethyl esters: 4 grams per day can help reduce median TG, VLDL-C, and non-HDL-C levels and increase median HDL-C from baseline.
- Fenofibrate: The initial dose is 54 mg per day to 160 mg per day, and dosage should be individualized according to patient response. It is essential to monitor lipid levels periodically and adjust treatment as needed 2 3.
From the Research
Methods to Lower Triglycerides
To lower hypertriglyceridemia, several methods can be employed, including:
- Medications such as niacin, fibrates, and omega-3 fatty acids 4, 5, 6
- Statin therapy, which can reduce triglyceride levels by up to 18% 5, 6
- Dietary changes, such as minimizing saturated fats and refined carbohydrates, and increasing fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 7
Medication Options
Medications that can help lower triglycerides include:
- Niacin, which can reduce plasma apoB and increase HDL cholesterol 8, 6
- Fibrates, which can reduce triglyceride-rich lipoproteins and remnant particles 4, 5, 6
- Omega-3 fatty acids, which can reduce triglyceride levels and prevent coronary plaque progression 5, 8, 7
Dietary Changes
Dietary changes can also play a crucial role in lowering triglycerides, including: