From the Guidelines
Treatment for hypertriglyceridemia should start with lifestyle changes, including weight loss, abstinence from alcohol, and dietary modifications.
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 (fasting triglycerides >150 mg/dL or nonfasting triglycerides >175 mg/dL), clinicians should address and treat lifestyle factors, secondary factors, and medications that raise triglycerides 1.
- Severe hypertriglyceridemia (fasting triglycerides ≥500 mg/dL and especially >1,000 mg/dL) may warrant pharmacologic therapy (fibrin acid derivatives and/or fish oil) and reduction in dietary fat to reduce the risk of acute pancreatitis 1.
- For patients with atherosclerotic cardiovascular disease or other cardiovascular risk factors on a statin with controlled LDL cholesterol but elevated triglycerides (150–499 mg/dL), the addition of icosapent ethyl can be considered to reduce cardiovascular risk 1.
Pharmacologic Therapy
- Fibrin acid derivatives and fish oil may be used to reduce triglyceride levels in patients with severe hypertriglyceridemia 1.
- Icosapent ethyl may be considered to reduce cardiovascular risk in patients with atherosclerotic cardiovascular disease or other cardiovascular risk factors on a statin with controlled LDL cholesterol but elevated triglycerides 1.
Lifestyle Modifications
- Weight loss and abstinence from alcohol are recommended for all patients with hypertriglyceridemia 1.
- Dietary modifications, including reduction in dietary fat, are recommended for patients with severe hypertriglyceridemia 1.
From the Research
Treatment Options for Hypertriglyceridemia
The treatment for hypertriglyceridemia involves a combination of lifestyle modifications and pharmacological interventions.
- Lifestyle modifications, such as cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control, are the most effective ways to lower triglyceride (TG) levels 2.
- The need to lower low-density lipoprotein (LDL) concentration must be determined on the basis of cardiovascular risk, independently of the success of lifestyle changes 2.
- Pharmacological treatment usually starts with statins, although associated TG reductions are typically modest 3.
- Fibrates are currently the drugs of choice for hypertriglyceridemia, frequently in combination with statins 3.
- Omega-3 fatty acids can also lower TG levels, with a daily dose of 2-4 g being effective 2, 3.
- Novel therapies, including anti-sense oligonucleotides and inhibitors of microsomal triglyceride transfer protein, have shown significant TG lowering efficacy 3, 4.
- Apolipoprotein C-III inhibitors, angiopoietin-like 3 inhibitors, alipogene tiparvovec, pradigastat, pemafibrate, and novel formulations of omega-3 fatty acids are also being developed as potential treatments for hypertriglyceridemia 4.
Specialized Treatment
- Patients with very rare purely genetic types of hypertriglyceridemia, such as familial chylomicronemia syndrome, should be treated in specialized outpatient clinics 2.
- Patients with severe hypertriglyceridemia are at high risk of pancreatitis, and reduction of severely elevated triglycerides is important to avert or reduce this risk 5, 6.
Management Strategies
- Correcting secondary causes of hypertriglyceridemia, such as obesity, uncontrolled diabetes, alcohol misuse, and various commonly used drugs, is important before starting drug treatment 6.
- Optimizing lifestyle choices, including dietary modification, is also crucial in managing hypertriglyceridemia 6.
- A step-by-step management strategy, including non-drug and drug approaches, can be adopted to treat hypertriglyceridemia 6.