From the Guidelines
Treatment for a male with hypercholesterolemia and hypertriglyceridemia should prioritize statin therapy to reduce LDL cholesterol, with lifestyle modifications and consideration of additional medications like fibrates for elevated triglycerides. The primary goal is to lower LDL cholesterol to a target goal of 100 mg/dl (2.60 mmol/l) using statins such as atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily) 1. For elevated triglycerides, fibrates like fenofibrate (145 mg daily) or omega-3 fatty acids (2-4 g daily) may be added to the treatment regimen. Key lifestyle modifications include:
- Adopting a Mediterranean or DASH diet low in saturated fats and refined carbohydrates
- Regular exercise (150 minutes of moderate activity weekly)
- Weight loss if overweight
- Limiting alcohol consumption
- Smoking cessation These interventions work synergistically to improve metabolic health and reduce the risk of cardiovascular disease. Regular monitoring of lipid levels every 3-6 months is necessary to assess treatment efficacy and adjust medications as needed, with liver function tests performed before starting therapy and periodically thereafter to monitor for potential side effects 1.
From the FDA Drug Label
The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. 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 a male with hypercholesterolemia and hypertriglyceridemia is dietary therapy and fenofibrate tablets as an adjunctive therapy to diet. The initial dose of fenofibrate tablet is 160 mg once daily for primary hypercholesterolemia or mixed dyslipidemia, and 54 mg per day to 160 mg per day for severe hypertriglyceridemia.
- Key considerations:
- Dietary therapy should be specific for the type of lipoprotein abnormality.
- Fenofibrate tablets should be given with meals to optimize bioavailability.
- Lipid levels should be monitored periodically and the dosage of fenofibrate tablets may need to be adjusted.
- Therapy should be withdrawn if there is no adequate response after two months of treatment with the maximum recommended dose. 2
From the Research
Treatment Options for Hypercholesterolemia and Hypertriglyceridemia
The treatment for a male with hypercholesterolemia (cholesterol 211) and hypertriglyceridemia (triglycerides 248) involves a combination of lifestyle modifications and pharmacotherapy.
- Lifestyle modifications include:
- Pharmacotherapy includes:
- Statins: to reduce low-density lipoprotein cholesterol (LDL-C) levels 5, 6
- Fibrates: to reduce triglyceride levels 4, 7
- Omega-3 fatty acids: to reduce triglyceride levels, with optimal doses of 3-4 g/day 5, 7
- Ezetimibe: to reduce LDL-C levels, can be used in combination with statins 6
- Bile acid sequestrants: to reduce LDL-C levels, can be used in combination with statins 6
- Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: to reduce LDL-C levels, can be used in patients with severely high total cholesterol 4
Efficacy of Treatment Options
The efficacy of these treatment options has been demonstrated in various studies:
- Lifestyle modifications can reduce total cholesterol by 23%, LDL-C by 23%, and triglycerides by 33% 3
- Statins can reduce LDL-C levels by 28-44% 5, 6
- Fibrates can reduce triglyceride levels by 25-35% 7
- Omega-3 fatty acids can reduce triglyceride levels by 25-45% 5, 7
- Ezetimibe and bile acid sequestrants can reduce LDL-C levels by 15-20% when used in combination with statins 6