From the Guidelines
Treatment for isolated hypertriglyceridemia should begin with lifestyle modifications, including weight loss, regular exercise, and dietary changes, as recommended by the 2021 ACC expert consensus decision pathway 1. The goal of these lifestyle modifications is to reduce triglyceride levels and minimize the risk of pancreatitis.
- Weight loss is considered the most effective lifestyle intervention to lower triglyceride levels, with a 5% to 10% reduction in body weight associated with a 20% decrease in triglycerides 1.
- Dietary changes, such as reducing simple carbohydrates, alcohol, and saturated fats, are also effective in lowering triglyceride levels.
- Regular exercise, such as aerobic exercise, can also help to reduce triglyceride levels.
For patients with triglyceride levels above 500 mg/dL, medication therapy may be necessary to reduce the risk of pancreatitis.
- First-line pharmacological treatment includes fibrates, such as fenofibrate (145 mg daily) or gemfibrozil (600 mg twice daily), which can reduce triglycerides by 30-50% 1.
- Omega-3 fatty acids (2-4 grams daily of EPA+DHA) are also effective and can be used alone or in combination with fibrates.
- For severe cases (>1000 mg/dL), statins may be added, with rosuvastatin (10-40 mg daily) or atorvastatin (20-80 mg daily) being most effective for triglyceride reduction.
- Niacin (1-2 grams daily) can reduce triglycerides by 20-40% but has more side effects, including flushing and potential liver issues.
Treatment should be monitored with lipid panels every 4-12 weeks initially, then every 3-6 months once stable.
- The goal is to reduce triglycerides below 500 mg/dL to minimize pancreatitis risk, with an optimal target below 150 mg/dL.
- These medications work by enhancing triglyceride clearance and reducing hepatic production of triglyceride-rich lipoproteins.
From the FDA Drug Label
The effects of fenofibrate on serum triglycerides were studied in two randomized, double-blind, placebo-controlled clinical trials of 147 hypertriglyceridemic patients Treatment of patients with elevated triglycerides often results in an increase of LDL-C (see Table 5) In a subset of the subjects, measurements of apo B were conducted. Fenofibrate treatment significantly reduced apo B from baseline to endpoint as compared with placebo (-25.1% vs. 2.4%, p < 0.0001, n=213 and 143 respectively).
Treatments for isolated hypertriglyceridemia include:
- Fenofibrate, which has been shown to decrease triglycerides and VLDL triglycerides and VLDL cholesterol in patients with hypertriglyceridemia 2 Key benefits of fenofibrate include:
- Reduction of triglycerides by 46.2% and 54.5% in two clinical trials
- Increase in HDL cholesterol by 19.6% and 22.9% in two clinical trials
- Reduction of VLDL triglycerides by 44.1% and 50.6% in two clinical trials However, treatment with fenofibrate may also result in an increase in LDL-C.
From the Research
Treatments for Isolated Hypertriglyceridemia
The treatments for isolated hypertriglyceridemia include:
- Lifestyle modifications, such as improved diet and increased physical activity, which are effective in lowering triglyceride levels 3, 4, 5, 6, 7
- Weight loss, which can reduce triglyceride levels by approximately 50% 6
- Pharmacological treatment, which usually starts with statins, although associated triglyceride reductions are typically modest 3
- Fibrates, which are currently the drugs of choice for hypertriglyceridemia, frequently in combination with statins 3, 4, 5, 7
- Omega-3 fatty acids, which can lower triglyceride levels, with a daily dose of 2-4 g being effective 4, 5
- Niacin, which can be considered in patients with low HDL levels and hypertriglyceridemia 5
Lifestyle Modifications
Lifestyle modifications play a crucial role in the treatment of hypertriglyceridemia, including:
- Dietary changes, such as a low saturated fat, carbohydrate-controlled diet 5, 6, 7
- Increased physical activity, such as regular aerobic exercise 5, 6
- Reduction in body mass index (BMI) 7
- Abstinence from alcohol consumption 4, 7
- Smoking cessation 5
Pharmacological Treatment
Pharmacological treatment for hypertriglyceridemia may involve:
- Statins, which are usually the first line of treatment, although they may not significantly lower triglyceride levels 3, 4, 5, 7
- Fibrates, which are effective in lowering triglyceride levels, and may be used in combination with statins 3, 4, 5, 7
- Omega-3 fatty acids, which can be used to lower triglyceride levels, particularly in patients with high-risk cardiovascular disease 4
- Niacin, which can be used to treat patients with low HDL levels and hypertriglyceridemia 5