What is the diagnosis for a 45-year-old male with hypertriglyceridemia (elevated triglycerides), elevated Low-Density Lipoprotein (LDL) cholesterol, and low High-Density Lipoprotein (HDL) cholesterol?

From the Guidelines

This 45-year-old male with significantly elevated triglycerides (500 mg/dL), borderline elevated LDL (123 mg/dL), and low HDL (34 mg/dL) requires immediate intervention to reduce the risk of pancreatitis and cardiovascular disease, and I recommend starting with lifestyle modifications and pharmacotherapy, including a statin and a fibrate or omega-3 fatty acids, as supported by the 2016 ESC/EAS guidelines for the management of dyslipidaemias 1. The patient's lipid profile indicates mixed dyslipidemia, which increases the risk of cardiovascular disease and pancreatitis.

• The primary goal is to reduce the triglyceride level to prevent pancreatitis, and according to the Endocrine Society guidelines, fibrates are the first-line treatment in patients with hypertriglyceridemia who are at risk of pancreatitis 1.
• Additionally, a statin should be used to address the LDL level and improve the HDL level, as recommended by the 2016 ESC/EAS guidelines, which suggest using a statin as the primary treatment to reach the LDL-C goal 1.
• Lifestyle modifications, such as reducing simple carbohydrate and alcohol intake, increasing physical activity to 150 minutes weekly, losing weight if overweight, and following a Mediterranean diet pattern, are also crucial in managing the patient's lipid profile.
• The patient should be screened for secondary causes of hypertriglyceridemia, including diabetes, hypothyroidism, kidney disease, and certain medications, as recommended by the Endocrine Society guidelines 1.
• Rechecking lipids in 6-12 weeks is necessary to assess treatment response and adjust therapy as needed, as supported by the American Heart Association and American Diabetes Association guidelines 1.

From the FDA Drug Label

LOVAZA 4 grams per day reduced median TG, VLDL-C, and non-HDL-C levels and increased median HDL-C from baseline relative to placebo. Treatment with LOVAZA to reduce very high TG levels may result in elevations in LDL-C and non-HDL-C in some individuals. Patients should be monitored to ensure that the LDL-C level does not increase excessively

The patient has severe hypertriglyceridemia with a triglyceride level of 500 mg/dL.

• The LDL level is 123 mg/dL, and the HDL level is 34 mg/dL.
• Based on the information from the drug label 2, LOVAZA (omega-3-acid ethyl esters) can be used to lower very high triglyceride levels in adults.
• The patient should be monitored to ensure that the LDL-C level does not increase excessively.
• It is recommended to use LOVAZA with caution and to monitor the patient's lipid levels regularly.

From the Research

Lipid Profile Management

The patient's lipid profile shows high triglycerides (500), elevated LDL (123), and low HDL (34) levels.

• The patient's triglyceride level is considered severe hypertriglyceridemia, which is a risk factor for acute pancreatitis and cardiovascular disease (CVD) 3.
• The patient's LDL level is elevated, and HDL level is low, which is characterized as the atherogenic lipid phenotype 4.

Treatment Options

• Statins are the first line of therapy for managing mild to moderate hypertriglyceridemia, but the patient may need additional reduction in triglyceride-rich lipoproteins and remnant particles to further reduce residual CVD risk 3.
• Fibrates, niacin, or long-chain omega-3 fatty acids may be added to statin therapy to reduce triglyceride levels and improve the lipid profile 4, 3, 5, 6.
• The choice of additional therapy depends on the patient's specific needs and the potential benefits and risks of each option 3, 5, 6.

Considerations for Treatment

• The patient's severe hypertriglyceridemia requires immediate attention, and the use of triglyceride-lowering agents is recommended 3.
• The patient's low HDL level and elevated LDL level should also be addressed through lifestyle modifications and potentially additional pharmacotherapy 4, 7.
• The potential benefits and risks of each treatment option should be carefully considered, and the patient's response to therapy should be closely monitored 3, 5, 6.