What are the treatment options for hypertriglyceridemia?

From the Guidelines

To treat high triglycerides, focus on lifestyle modifications and medication when necessary, prioritizing fibrates and omega-3 fatty acids for severe cases, as recommended by the most recent guidelines 1. The treatment of hypertriglyceridemia involves a combination of lifestyle modifications and medication.

• Lifestyle modifications include:
  • Improving diet by reducing intake of refined carbohydrates, sugary foods, and alcohol
  • Increasing consumption of omega-3 rich foods like fatty fish
  • Weight loss, aiming for a 5-10% reduction in body weight, which can significantly lower triglyceride levels
  • Regular exercise, such as at least 150 minutes per week of moderate-intensity activity, to reduce triglycerides directly
• Medication options include:
  • Fibrates, such as fenofibrate (145mg daily) or gemfibrozil (600mg twice daily), which are commonly prescribed specifically for high triglycerides
  • Statins, such as atorvastatin (10-80mg daily) or rosuvastatin (5-40mg daily), which may be used, especially if cholesterol is also elevated
  • Prescription omega-3 fatty acids (Lovaza, Vascepa) at 2-4g daily, which can reduce triglycerides by 20-50%
  • Niacin (500-2000mg daily), which is sometimes used but has more side effects According to the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1, therapies should be implemented to reduce excesses in both chylomicrons and VLDL in severe hypertriglyceridemia.
• For patients with triglycerides 500 to 999 mg/dL, 20% to 25% of calories from fat are recommended
• For patients with triglycerides ≥1,000 mg/dL, 10% to 15% of calories from fat are recommended Regular monitoring through blood tests is important to assess effectiveness and adjust treatment as needed, as recommended by the Endocrine Society guidelines 1.

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 treatment options for hypertriglyceridemia include:

• Dietary therapy: specific for the type of lipoprotein abnormality
• Lifestyle modifications: addressing excess body weight and excess alcoholic intake, and incorporating physical exercise
• Treatment of underlying diseases: such as hypothyroidism or diabetes mellitus
• Fenofibrate therapy: as an adjunct to diet, with initial doses ranging from 54 mg to 160 mg per day, depending on patient response and renal function 2 2
• Discontinuation of etiologic agents: such as estrogen therapy, thiazide diuretics, and beta-blockers, which may be associated with massive rises in plasma triglycerides.

From the Research

Treatment Options for Hypertriglyceridemia

The treatment options for hypertriglyceridemia include:

• Lifestyle modifications, such as changes in diet, exercise, reduction in body mass index, and abstinence from alcohol consumption 3
• Pharmacotherapy with fibrates and statins 3, 4
• Prescription omega-3 fatty acids, which have been shown to reduce triglyceride levels by 45% and very low-density lipoprotein cholesterol levels by more than 50% in patients with triglyceride levels above 500 mg/dl 5
• Niacin, which can be used to reduce triglyceride levels, although it may have adverse effects 5, 6

Lifestyle Modifications

Lifestyle modifications are the primary intervention for managing triglycerides ≥ 10 mmol/L, and include:

• Dietary changes, such as lowering carbohydrate intake and increasing fat and protein intake 4
• Moderate- to high-intensity physical activity to lower triglyceride levels and improve body composition and exercise capacity 4
• Reduction in body mass index and abstinence from alcohol consumption 3

Pharmacotherapy

Pharmacotherapy options for hypertriglyceridemia include:

• Statins, which can be considered for patients with high triglyceride levels who have borderline or intermediate risk of atherosclerotic cardiovascular disease 4
• Fibrates, such as gemfibrozil and fenofibrate, which can be used to reduce triglyceride levels in patients with severely elevated triglyceride levels 4, 5, 6
• Omega-3 fatty acids, which can be used to reduce triglyceride levels and cardiovascular mortality in patients with high triglyceride levels 4, 5, 6
• Niacin, which can be used to reduce triglyceride levels, although it may have adverse effects 5, 6

Severe Hypertriglyceridemia

In cases of severe hypertriglyceridemia, the therapeutic management represents a clinical challenge, and may involve:

• Identification and correction of secondary causes, such as obesity and diabetes 7
• Pharmacological treatments, such as fenofibrate and gemfibrozil, although the use of omega-3 fatty acids and niacin may be limited 7
• Insulin infusion and plasmapheresis in cases of acute pancreatitis associated with hypertriglyceridemia 4