What is the treatment for hypertriglyceridemia?

From the Guidelines

The treatment for hypertriglyceridemia should prioritize lifestyle modifications, including weight loss, regular exercise, and a low-fat diet, and for patients with triglyceride levels above 500 mg/dL, medications such as fibrates or omega-3 fatty acids should be considered to reduce the risk of pancreatitis. According to the most recent guidelines 1, lifestyle interventions, treatment of secondary factors, and avoidance of medications that might raise triglycerides are recommended for individuals with hypertriglyceridemia.

Key Lifestyle Modifications

• Weight loss
• Regular exercise
• Limiting alcohol consumption
• Adopting a low-fat diet with reduced simple carbohydrates

Medication Therapy

For patients with triglyceride levels above 500 mg/dL, medications are typically recommended to reduce the risk of pancreatitis.

• Fibrates such as fenofibrate or gemfibrozil are commonly prescribed as first-line drug therapy
• Omega-3 fatty acids are also effective and can be used alone or in combination with fibrates
• Statins like atorvastatin or rosuvastatin may be added for patients with very high triglyceride levels or those not responding to initial therapy, particularly if LDL cholesterol is also elevated

Monitoring and Adjustment

Regular monitoring of lipid levels every 3-6 months is important to assess treatment effectiveness and adjust therapy as needed, as recommended by previous studies 1.

Specific Considerations

• For patients with severe hypertriglyceridemia (fasting triglycerides ≥500 mg/dL), evaluation for secondary causes and consideration of medical therapy to reduce the risk of pancreatitis is recommended 1
• The addition of icosapent ethyl can be considered to reduce cardiovascular risk in individuals with ASCVD or other cardiovascular risk factors on a statin with managed LDL cholesterol but elevated triglycerides 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 hypertriglyceridemia is:

• Dietary therapy: The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality.
• Fenofibrate tablets: As adjunctive therapy to diet, to reduce elevated triglycerides in adult patients with primary hypercholesterolemia or mixed dyslipidemia, and for the treatment of adult patients with severe hypertriglyceridemia.
• Dosage: The initial dose of fenofibrate tablet is 54 mg per day to 160 mg per day for severe hypertriglyceridemia, and 160 mg once daily for primary hypercholesterolemia or mixed dyslipidemia.
• Lifestyle modifications: 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. 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 changes, such as improved diet and increased physical activity, which are effective in lowering triglyceride levels 3
• Statins, which are often the first line of therapy, although they may only modestly reduce triglyceride levels 3, 4
• Fibrates, which are commonly used in combination with statins to treat hypertriglyceridemia 3, 5
• Niacin and omega-3 fatty acids, which can be used to improve control of triglyceride levels when other measures are not effective 3, 5
• Novel therapies, such as anti-sense oligonucleotides and inhibitors of microsomal triglyceride transfer protein, which have shown promise in reducing triglyceride levels 3

Pharmacological Treatment

Pharmacological treatment for hypertriglyceridemia often involves a combination of medications, including:

• Statins, which reduce low-density lipoprotein cholesterol levels and also have a modest effect on triglyceride levels 4
• Fibrates, which are effective in reducing triglyceride levels and are often used in combination with statins 5, 4
• Omega-3 fatty acids, which have been shown to reduce triglyceride levels by 20-50% in patients with hypertriglyceridemia 6
• Niacin, which can be used to improve control of triglyceride levels, although it may have adverse effects 5, 4

Combination Therapy

Combination therapy, such as the use of omega-3 fatty acids and a statin, can be a safe and effective way to improve lipid levels and cardiovascular prognosis beyond the benefits provided by statin therapy alone 6. The concomitant use of prescription omega-3 fatty acids and fenofibrate has also been shown to result in a greater reduction in triglyceride levels compared to fenofibrate alone 7.