From the Guidelines
The treatment approach for elevated triglyceride levels should prioritize lifestyle modifications for mild to moderate elevations (150-499 mg/dL) and consider medical therapy for levels ≥500 mg/dL to reduce the risk of pancreatitis, as recommended by the most recent guidelines 1.
Key Recommendations
- For individuals with fasting triglyceride levels ≥500 mg/dL, evaluate for secondary causes of hypertriglyceridemia and consider medical therapy to reduce the risk of pancreatitis 1.
- In adults with hypertriglyceridemia, clinicians should address and treat lifestyle factors, secondary factors, and medications that raise triglycerides 1.
- Lifestyle interventions, including weight loss, regular exercise, limiting alcohol, and adopting a low-carbohydrate, low-fat diet, are essential for managing hypertriglyceridemia 1.
Medication Therapy
- First-line medications for hypertriglyceridemia include fibrates, omega-3 fatty acids, and statins, particularly for individuals with elevated LDL cholesterol 1.
- For severe hypertriglyceridemia (>1000 mg/dL), a combination of these medications may be necessary, along with immediate dietary fat restriction 1.
Monitoring and Treatment Goals
- Regular monitoring of triglyceride levels is crucial, with treatment goals aiming for levels below 150 mg/dL 1.
- Addressing underlying causes, such as diabetes, hypothyroidism, or medication side effects, is also essential for effective management 1.
From the FDA Drug Label
The NCEP Treatment Guidelines: LDL-C Goals and Cutpoints for Therapeutic Lifestyle Changes and Drug Therapy in Different Risk Categories LDL Level at Which to Initiate which to Consider Therapeutic Lifestyle(mg/ dL)LDL Level at Which to Initiate which to Consider Drug Therapy(mg/ dL) Risk CategoryLDL Goal (mg/dL) After the LDL-C goal has been achieved, if the TG is still > 200 mg/dL, non HDL-C (Total-C minus HDL-C) becomes a secondary target of therapy Non-HDL-C goals are set 30 mg/dL higher than LDL-C goals for each risk category.
The treatment approach for elevated triglyceride (hypertriglyceridemia) levels involves:
- Dietary therapy: The initial treatment of dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality.
- Lifestyle changes: 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.
- Drug therapy: Should be considered only when reasonable attempts have been made to obtain satisfactory results with non-drug methods.
- Fenofibrate 2 is indicated as adjunctive therapy to diet for treatment of adult patients with hypertriglyceridemia.
- Niacin 3 is indicated as adjunctive therapy for the treatment of adult patients with very high serum triglyceride levels who present a risk of pancreatitis and who do not respond adequately to a determined dietary effort to control them.
- Triglyceride levels:
- > 200 mg/dL: Non-HDL-C becomes a secondary target of therapy after the LDL-C goal has been achieved.
- > 1,000 mg/dL: Therapy with nicotinic acid may be considered for those subjects with triglyceride elevations who have a history of pancreatitis or of recurrent abdominal pain typical of pancreatitis.
- > 2,000 mg/dL: May increase the risk of developing pancreatitis.
From the Research
Treatment Approach for Elevated Triglyceride Levels
The treatment approach for elevated triglyceride levels, also known as hypertriglyceridemia, involves a combination of lifestyle modifications and pharmacotherapy.
- The primary goal of treatment is to reduce the risk of cardiovascular events and acute pancreatitis associated with high triglyceride levels 4, 5, 6.
- Lifestyle modifications include a healthy diet, regular exercise, tobacco-use cessation, and weight management 4, 7.
- Pharmacotherapy may be indicated for patients with borderline-high or high triglyceride levels, and may include statins, fibrates, niacin, and omega-3 fatty acids 4, 5, 6, 8.
Triglyceride Level Thresholds for Treatment
- Borderline-high triglyceride levels: 150-199 mg/dL (1.70-2.25 mmol/L) 4.
- High triglyceride levels: 200-499 mg/dL (2.26-5.64 mmol/L) 4.
- Very high triglyceride levels: ≥500 mg/dL (≥5.65 mmol/L) 4, 6, 8.
Pharmacotherapy Options
- Statins: primarily used to lower low-density lipoprotein cholesterol levels, but also effective in reducing triglyceride levels 4, 5, 6.
- Fibrates: effective in lowering triglyceride levels and often used in combination with statins 4, 5, 6.
- Niacin: used to raise high-density lipoprotein cholesterol levels and lower triglyceride levels 4, 5, 6.
- Omega-3 fatty acids: effective in lowering triglyceride levels, particularly in patients with very high triglyceride levels 5, 6, 8.