From the Guidelines
To lower elevated triglycerides, focus on lifestyle modifications first, including weight loss if overweight, regular exercise, and dietary changes such as reducing sugar, refined carbohydrates, and alcohol while increasing omega-3 fatty acids from fatty fish, as recommended by the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1. The most effective lifestyle intervention to lower triglyceride levels is weight loss, with a 5% to 10% reduction in body weight associated with a 20% decrease in triglycerides 1. Regular physical activity, such as at least 150 minutes per week of accumulated moderate-intensity aerobic physical activity, is also recommended to reduce ASCVD risk and lower triglycerides 1. Dietary changes, including reducing saturated fat to less than 7% of energy intake and increasing viscous fiber and plant stanols/sterols, can also help lower triglycerides 1. For medication, statins like atorvastatin or rosuvastatin, fibrates such as fenofibrate, and prescription omega-3 fatty acids like icosapent ethyl are effective treatments for elevated triglycerides 1. Key points to consider when treating elevated triglycerides include:
- Lifestyle modifications as the first line of therapy
- Weight loss as the most effective lifestyle intervention
- Regular physical activity to reduce ASCVD risk and lower triglycerides
- Dietary changes to reduce saturated fat and increase viscous fiber and plant stanols/sterols
- Medication, such as statins, fibrates, and omega-3 fatty acids, for severely elevated levels or when lifestyle modifications are not effective.
From the FDA Drug Label
To reduce elevated TC, LDL-C, Apo B and TG, and to increase HDL-C in patients with primary hyperlipidemia and mixed dyslipidemia. To reduce TG in adult patients with severe hypertriglyceridemia. Fenofibrate therapy lowered LDL-C, Total-C, and the LDL-C/HDL-C ratio. Fenofibrate therapy also lowered triglycerides and raised HDL-C. The effects of fenofibrate on serum triglycerides were studied in two randomized, double-blind, placebo-controlled clinical trials of 147 hypertriglyceridemic patients.
Lowering Elevated Triglycerides:
- Fenofibrate can be used to lower triglycerides in patients with hypertriglyceridemia.
- Niacin extended-release tablets can also be used to reduce TG in adult patients with severe hypertriglyceridemia.
- The dosage of fenofibrate is 160 mg per day, and the dosage of niacin extended-release tablets ranges from 500 mg to 2000 mg once daily.
- It is essential to monitor liver enzymes and glucose levels during treatment with these medications.
- Patients should be advised to follow an appropriate lipid-modifying diet while taking these medications 2, 3.
- Key considerations include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for potential side effects such as flushing, diarrhea, and increased liver enzymes
- Adjusting the dose or discontinuing the medication if adverse effects occur
From the Research
Lifestyle Changes to Lower Triglycerides
- Brisk walking can be an effective intervention for overweight/obese middle-aged women with hypertriglyceridemia in reducing cardiovascular risk by lowering triglyceride and apolipoprotein B levels 4
- A formula diet rich in omega-3 fatty acids and medium-chain triglycerides can rapidly decrease plasma triglyceride levels in patients with severe hypertriglyceridemia 5
Medications to Lower Triglycerides
- Fibrates, such as fenofibrate and gemfibrozil, can safely and significantly reduce serum triglyceride levels in patients with type IIb hyperlipidemia 6
- Long-chain omega-3 fatty acids may be a well-tolerated and effective alternative to fibrates and niacin for reducing triglyceride levels in patients with hypertriglyceridemia 7
- The combination of fluvastatin and fibrates can improve lipid profiles, with reductions in triglycerides, low-density lipoprotein (LDL) cholesterol, and non-high-density lipoprotein (non-HDL) cholesterol that are dependent on baseline triglyceride levels 8