What are the recommendations for reducing elevated triglycerides (hypertriglyceridemia)?

From the Guidelines

To reduce elevated triglycerides, a combination of lifestyle modifications including a 5-10% weight loss, at least 150 minutes of moderate-intensity aerobic physical activity per week, and dietary changes is recommended. This approach is supported by the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1. The benefits of physical activity on triglyceride levels are well-documented, with regular aerobic exercise training decreasing triglycerides by about 11% 1. Additionally, a 5-10% reduction in body weight is associated with a 20% decrease in triglycerides 1.

Lifestyle Interventions

• Weight loss: Aim for a 5-10% reduction in body weight to achieve a 20% decrease in triglycerides 1
• Physical activity: Engage in at least 150 minutes of moderate-intensity aerobic physical activity per week 1
• Dietary changes: Reduce sugar, refined carbohydrates, and alcohol, and increase omega-3 fatty acids from fish like salmon and sardines

Additional Recommendations

• Medications may be necessary for severely elevated levels, with fibrates like fenofibrate or gemfibrozil being first-line options
• Omega-3 supplements (2-4g daily of EPA/DHA) can also help
• Statins like atorvastatin or rosuvastatin may be added, especially with concurrent high LDL cholesterol
• Avoid trans fats completely and limit saturated fats
• Replace simple carbohydrates with complex ones from vegetables, legumes, and whole grains

These approaches work by reducing the liver's production of triglycerides and enhancing their clearance from the bloodstream. For those with diabetes, improving glucose control is essential as high blood sugar drives triglyceride production. By following these recommendations, individuals can effectively reduce their elevated triglycerides and improve their overall cardiovascular health.

From the FDA Drug Label

Fenofibrate therapy also lowered triglycerides and raised HDL-C (see Table 4). 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 patients with hypertriglyceridemia and normal cholesterolemia with or without hyperchylomicronemia, treatment with fenofibrate at dosages equivalent to fenofibrate 160 mg per day decreased primarily very low density lipoprotein (VLDL) triglycerides and VLDL cholesterol.

The recommendations for reducing elevated triglycerides (hypertriglyceridemia) include:

• Fenofibrate therapy: Fenofibrate has been shown to lower triglycerides and raise HDL-C.
• Dietary changes: Patients should be advised to continue to follow an appropriate lipid-modifying diet while taking fenofibrate tablets.
• Monitoring: Patients should return to their physician’s office for routine monitoring. 2

From the Research

Recommendations for Reducing Elevated Triglycerides

The following are recommendations for reducing elevated triglycerides (hypertriglyceridemia) based on current evidence:

• Lifestyle changes are effective in lowering triglyceride levels, including:
  • Improved diet 3, 4, 5
  • Increased physical activity 3, 4
• Dietary changes that can help lower triglyceride levels include:
  • Lowering carbohydrate intake, especially refined carbohydrates 4
  • Increasing fat intake, especially omega-3 fatty acids 4, 6
  • Increasing protein intake 4
• Pharmacological treatment options for hypertriglyceridemia include:
  • Statins, which can help lower triglyceride levels, especially in patients with high cardiovascular risk 3, 4
  • Fibrates, which are effective in lowering triglyceride levels, especially in combination with statins 3, 7, 6, 5
  • Omega-3 fatty acids, which can help lower triglyceride levels, especially in patients with very high triglyceride levels 7, 6, 5
  • Niacin, which can help lower triglyceride levels, especially in patients with severely elevated triglyceride levels 3, 6
• Novel therapies, such as anti-sense oligonucleotides and inhibitors of microsomal triglyceride transfer protein, have shown significant triglyceride-lowering efficacy 3
• For patients with severely elevated triglyceride levels, high-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality 4
• For patients with acute pancreatitis associated with hypertriglyceridemia, insulin infusion and plasmapheresis should be considered if triglyceride levels remain high despite conservative management 4