What are the methods to reduce elevated triglycerides (hypertriglyceridemia)?

From the Guidelines

To reduce elevated triglycerides, lifestyle interventions, including a weight loss of 5% to 10%, are the first line of therapy, and can lead to a 20% decrease in triglycerides, as recommended by the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1. The management of hypertriglyceridemia involves a multifaceted approach, including lifestyle modifications and pharmacological interventions.

• Lifestyle changes, such as adopting a Mediterranean or low-carbohydrate diet, limiting alcohol, exercising regularly for at least 150 minutes per week of moderate-intensity aerobic physical activity, losing weight if overweight, and avoiding added sugars and refined carbohydrates, are essential for reducing triglyceride levels 1.
• Specific dietary changes, including eating fatty fish like salmon twice weekly, choosing olive oil over saturated fats, increasing fiber intake through vegetables and whole grains, and limiting fructose from sweetened beverages, can also help lower triglycerides.
• For patients with severe hypertriglyceridemia, medication options, such as statins (like atorvastatin 10-80mg daily), fibrates (like fenofibrate 145mg daily), omega-3 fatty acids (2-4g daily), or niacin (500-2000mg daily), may be prescribed by a doctor 1.
• Supplements like fish oil (2-4g daily) may also be beneficial, but pharmaceutical-grade versions are more reliable.
• Regular monitoring through blood tests is crucial to track progress, with a goal of bringing triglycerides below 150 mg/dL. The effects of lifestyle modifications on elevated triglyceride levels are well-documented, with a dose-response relationship present between the amount of weight lost by lifestyle intervention and triglyceride lowering 1.
• A 5% to 10% reduction in body weight is associated with a 20% decrease in triglycerides, and triglycerides may be lowered by at least 50% to 70% in response to weight loss.
• Physical activity, such as aerobic exercise, can also decrease triglycerides by about 11%, and regular endurance exercise training can mobilize body fat, assist with weight loss, and alter body composition, leading to improvements in carbohydrate and lipid metabolism 1.

From the FDA Drug Label

To reduce elevated TC, LDL-C, Apo B and TG, and to increase HDL-C in patients with primary hyperlipidemia and mixed dyslipidemia. To reduce TG in adult patients with severe hypertriglyceridemia. Fenofibrate therapy lowered triglycerides and raised HDL-C Treatment with fenofibrate at dosages equivalent to fenofibrate 145 mg per day decreased primarily very low density lipoprotein (VLDL) triglycerides and VLDL cholesterol.

The methods to reduce elevated triglycerides (hypertriglyceridemia) include:

• Fenofibrate therapy: lowers triglycerides and raises HDL-C 2
• Niacin extended-release tablets: reduces TG in adult patients with severe hypertriglyceridemia 3 Key points to consider when using these methods:
• Dose and administration: Fenofibrate 145 mg per day, Niacin extended-release tablets 500 mg to 2000 mg once daily 2 3
• Monitoring: Liver enzymes, glucose levels, and lipid parameters should be monitored during treatment 2 3

From the Research

Methods to Reduce Elevated Triglycerides

The following methods can be used to reduce elevated triglycerides:

• Lifestyle modifications:
  • Dietary changes, such as lowering carbohydrate intake and increasing fat and protein intake 4, 5, 6
  • Increasing physical activity, such as moderate- to high-intensity exercise 4, 5, 6
  • Weight loss and blood sugar control 5, 6
  • Abstinence from alcohol consumption 5, 6
• Pharmacotherapy:
  • Prescription omega-3 fatty acids, which contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) 7, 4, 5
  • Fibrates, such as gemfibrozil or fenofibrate 7, 4, 5
  • Niacin 7, 4
  • Statins, which can be considered for patients with high triglyceride levels who have borderline or intermediate risk of atherosclerotic cardiovascular disease 4
• Other treatments:
  • A formula diet rich in omega-3 fatty acids and medium-chain triglycerides, which can rapidly decrease plasma triglyceride levels 8
  • Insulin infusion and plasmapheresis, which can be considered for patients with acute pancreatitis associated with hypertriglyceridemia 4

Specific Treatment Recommendations

• For patients with triglyceride levels above 500 mg/dl, approximately 4 g/day of EPA and DHA can reduce triglyceride levels by 45% and very low-density lipoprotein cholesterol levels by more than 50% 7
• For patients with severely elevated triglyceride levels, fibrates, omega-3 fatty acids, or niacin can be considered to reduce the risk of pancreatitis 4
• For patients with acute pancreatitis associated with hypertriglyceridemia, insulin infusion and plasmapheresis can be considered if triglyceride levels remain at 1,000 mg/dl or higher despite conservative management 4