From the Guidelines
Management of hypertriglyceridemia should prioritize lifestyle modifications, including dietary changes and weight loss, as well as pharmacological interventions, with the goal of reducing triglyceride levels below 150 mg/dL and preventing acute pancreatitis. The most recent and highest quality study, 1, recommends evaluating for secondary causes of hypertriglyceridemia and considering medical therapy to reduce the risk of pancreatitis in individuals with fasting triglyceride levels ≥500 mg/dL.
Lifestyle Modifications
Lifestyle modifications are essential in the management of hypertriglyceridemia, including:
- Reducing intake of simple carbohydrates, saturated fats, and alcohol
- Increasing consumption of omega-3 fatty acids and fiber
- Weight loss for overweight individuals
- Regular exercise
- Strict glycemic control for diabetic patients
Pharmacological Interventions
Pharmacological interventions may be necessary for moderate to severe hypertriglyceridemia, including:
- Statins for moderate elevations (150-499 mg/dL), particularly when LDL cholesterol is also elevated
- Fibrates, such as fenofibrate (145 mg daily) or gemfibrozil (600 mg twice daily), for severe hypertriglyceridemia (≥500 mg/dL) to reduce pancreatitis risk
- Prescription omega-3 fatty acids, such as icosapent ethyl (2g twice daily) or omega-3 ethyl esters (2-4g daily), as effective alternatives
- Niacin (1-2g daily) may also lower triglycerides, but has more side effects, including flushing and potential liver toxicity
Treatment Targets
Treatment targets typically aim for triglyceride levels below 150 mg/dL, with priority given to reducing levels below 500 mg/dL to prevent acute pancreatitis. Regular monitoring of lipid levels, liver function, and muscle symptoms is important during pharmacological treatment, as recommended by 1.
Severe Hypertriglyceridemia
For extremely high levels (>1000 mg/dL), combination therapy may be necessary, and very low-fat diets (<15% of calories) might be temporarily required, as suggested by 1 and 1.
Secondary Causes
It is essential to evaluate for secondary causes of hypertriglyceridemia, such as diabetes, chronic liver or kidney disease, and hypothyroidism, and address these conditions as part of the management plan, as recommended by 1.
Conclusion is not allowed, so the response is ended here.
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.
The management options for hypertriglyceridemia include:
- Dietary therapy: specific for the type of lipoprotein abnormality
- Addressing excess body weight and alcoholic intake
- Physical exercise as an ancillary measure
- Treatment of underlying diseases such as hypothyroidism or diabetes mellitus
- Fenofibrate tablets as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia 2 2
From the Research
Management Options for Hypertriglyceridemia
The management of hypertriglyceridemia involves a combination of lifestyle modifications and pharmacological interventions. The primary goal is to reduce the risk of cardiovascular disease and pancreatitis associated with elevated triglyceride levels.
Lifestyle Modifications:
- Cessation of alcohol consumption 3
- Reduced intake of rapidly metabolized carbohydrates 3
- Weight loss 3, 4, 5
- Blood sugar control 3
- Healthy diet 4, 5
- Regular exercise 4, 5
- Tobacco-use cessation 4
- Lowering carbohydrate intake (especially refined carbohydrates) and increasing fat (especially omega-3 fatty acids) and protein intake 5
- Moderate- to high-intensity physical activity 5
Pharmacological Interventions:
- Statins: primarily target elevated low-density lipoprotein cholesterol levels, but also reduce mean triglyceride levels by up to 18% 6
- Fibrates: can lower triglyceride concentrations, but their efficacy in combination with statins has not been clearly shown in endpoint studies 3, 6
- Omega-3 fatty acids: can lower triglyceride levels, with free fatty acid forms exhibiting higher bioavailability and efficacy compared to ethyl ester forms 6, 7
- Niacin: can be considered for patients with severely elevated triglyceride levels to reduce the risk of pancreatitis 4, 6
- High-dose icosapent (purified eicosapentaenoic acid): can reduce cardiovascular mortality in high-risk patients with high triglyceride levels despite statin use 5
Special Considerations
- Patients with very high triglyceride levels (≥500 mg/dL) require immediate use of triglyceride-lowering agents to reduce the risk of acute pancreatitis 6
- Patients with acute pancreatitis associated with hypertriglyceridemia may require insulin infusion and plasmapheresis if triglyceride levels remain high despite conservative management 5
- Patients with purely genetic types of hypertriglyceridemia (familial chylomicronemia syndrome) should be treated in specialized outpatient clinics 3