From the Guidelines
To decrease triglycerides, focus on lifestyle changes including adopting a low-carbohydrate diet, limiting alcohol consumption, increasing physical activity to at least 150 minutes of moderate exercise weekly, and losing weight if overweight, as recommended by the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1.
Key Lifestyle Changes
- Reduce intake of sugary foods, refined carbohydrates, and saturated fats
- Increase consumption of omega-3 fatty acids found in fatty fish like salmon and mackerel
- Aim for a weight loss of 5% to 10% to achieve a 20% reduction in triglycerides, as supported by the 2021 ACC expert consensus decision pathway 1 and further emphasized by the benefits of physical activity in reducing triglyceride levels 1.
Medications for High Triglyceride Levels
For those with very high triglyceride levels (over 500 mg/dL), medications may be necessary, with common prescription options including:
- Fibrates (fenofibrate, gemfibrozil)
- Omega-3 fatty acid supplements (prescription-strength doses of 2-4 grams daily)
- Statins (atorvastatin, rosuvastatin), which have a modest triglyceride-lowering effect 1 Niacin may also be prescribed but has more side effects.
Importance of Reduction
High triglycerides contribute to cardiovascular disease risk and can lead to pancreatitis when severely elevated, making reduction important for overall health, as highlighted by the need to manage ASCVD risk reduction in patients with persistent hypertriglyceridemia 1. Regular monitoring through blood tests is essential to track progress and adjust treatment as needed.
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 160 mg per day decreased primarily very low density lipoprotein (VLDL) triglycerides and VLDL cholesterol.
Decreasing Triglycerides:
- Fenofibrate therapy can lower triglycerides and raise HDL-C 2.
- Niacin extended-release tablets can reduce elevated TG in patients with primary hyperlipidemia and mixed dyslipidemia, and in adult patients with severe hypertriglyceridemia 3.
- Treatment with fenofibrate at dosages equivalent to 160 mg per day can decrease VLDL triglycerides and VLDL cholesterol 2.
- The dose range for niacin extended-release tablets is 500 mg to 2000 mg once daily, with a maintenance dose of 1000 to 2000 mg once daily 3.
From the Research
Methods to Decrease Triglycerides
To decrease triglycerides, several methods can be employed, including:
- Medications such as omega-3 fatty acids and fenofibrate, which have been shown to be effective in reducing triglyceride levels 4, 5, 6
- Dietary changes, such as minimizing saturated fats and refined carbohydrates, eliminating trans-fat, and increasing fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 7
- Alternative treatments, such as fish oil, which may be less effective than fibrates but can still be beneficial for patients with moderately elevated triglycerides 8
Medication Options
Medications that can help decrease triglycerides include:
- Omega-3 fatty acids, which have been shown to decrease triglycerides by 21% 4 and are a well-tolerated and effective alternative to fibrates and niacin 5
- Fenofibrate, which has been shown to decrease triglycerides by 29% 4 and is more effective than omega-3 fatty acids in reducing triglyceride levels 6
- Fibrates, which are more effective than fish oil in reducing triglyceride levels 8
Dietary Changes
Dietary changes that can help decrease triglycerides include:
- Minimizing saturated fats and refined carbohydrates 7
- Eliminating trans-fat 7
- Increasing fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 7
- Adhering to a Mediterranean diet, which is strongly recommended for lowering cardiovascular disease and total mortality 7
Combination Therapy
Combination therapy, such as using omega-3 fatty acids and fenofibrate together, may be more effective than using a single medication alone 6. However, the effectiveness of combination therapy may vary depending on the individual patient and their specific needs.