From the Guidelines
Hypertriglyceridemia should be managed with lifestyle modifications and medication, prioritizing the reduction of triglyceride levels to prevent acute pancreatitis and cardiovascular disease, with the most recent guidelines recommending a rigorous approach for patients with triglycerides ≥1,000 mg/dL, including a diet with 10% to 15% of calories from fat 1.
Key Considerations
- Hypertriglyceridemia is characterized by elevated levels of triglycerides in the blood, typically above 150 mg/dL.
- Treatment depends on severity, with lifestyle modifications including a low-fat diet, regular exercise, weight loss if overweight, limiting alcohol consumption, and avoiding refined carbohydrates and sugars.
- For moderate to severe cases (triglycerides >500 mg/dL), medication is often necessary, with first-line pharmacological options including statins, fibrates, and omega-3 fatty acids.
- The 2021 ACC expert consensus decision pathway recommends a very rigorous approach for patients with triglycerides ≥1,000 mg/dL, including a diet with 10% to 15% of calories from fat 1.
Management Strategies
- Lifestyle modifications:
- Low-fat diet (less than 30% of calories from fat)
- Regular exercise (at least 30 minutes daily)
- Weight loss if overweight
- Limiting alcohol consumption
- Avoiding refined carbohydrates and sugars
- Medication:
- Statins (e.g., atorvastatin, rosuvastatin)
- Fibrates (e.g., fenofibrate, gemfibrozil)
- Omega-3 fatty acids
Monitoring and Follow-up
- Regular monitoring of triglyceride levels is essential, typically every 3-6 months after starting treatment.
- Addressing underlying conditions such as diabetes, obesity, and metabolic syndrome is crucial for effective management.
- The Endocrine Society recommends evaluating patients with primary hypertriglyceridemia for family history of dyslipidemia and cardiovascular disease, as well as assessing for other cardiovascular risk factors 1.
From the FDA Drug Label
Fenofibrate tablets are indicated as adjunctive therapy to diet to reduce elevated ... Triglycerides ... in adult patients with primary hypercholesterolemia or mixed dyslipidemia. Fenofibrate tablets are also indicated as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia.
Hypertriglyceridemia Treatment: Fenofibrate is indicated as adjunctive therapy to diet for the treatment of adult patients with severe hypertriglyceridemia. The initial dose for severe hypertriglyceridemia is 54 mg per day to 160 mg per day, and dosage should be individualized according to patient response 2.
- Key Points:
- Fenofibrate is used to reduce triglycerides in patients with hypertriglyceridemia.
- The initial dose for severe hypertriglyceridemia is 54 mg per day to 160 mg per day.
- Dosage should be individualized according to patient response 2.
From the Research
Definition and Risk Factors
- Hypertriglyceridemia is defined as fasting serum triglyceride levels of 150 mg per dL or higher, and is associated with increased risk of cardiovascular disease 3.
- Severely elevated triglyceride levels (500 mg per dL or higher) increase the risk of pancreatitis 3, 4.
- Common risk factors for hypertriglyceridemia include obesity, metabolic syndrome, and type 2 diabetes mellitus 3.
- Less common risk factors include excessive alcohol use, physical inactivity, being overweight, use of certain medications, and genetic disorders 3.
Management and Treatment
- Management of high triglyceride levels starts with dietary changes and physical activity to lower cardiovascular risk 3, 4.
- Lowering carbohydrate intake and increasing fat and protein intake can lower triglyceride levels 3.
- Moderate- to high-intensity physical activity can lower triglyceride levels, as well as improve body composition and exercise capacity 3.
- Statins can be considered for patients with high triglyceride levels who have borderline or intermediate risk of atherosclerotic cardiovascular disease 3.
- Fibrates, omega-3 fatty acids, or niacin should be considered for patients with severely elevated triglyceride levels to reduce the risk of pancreatitis 3, 4, 5, 6, 7.
Pharmacological Treatment
- Long-chain omega-3 fatty acids may be a well-tolerated and effective alternative to fibrates and niacin for lowering triglyceride levels 5, 7.
- Fibrates can lower triglyceride concentrations, but their efficacy in combination with statins has not been clearly shown in endpoint studies 4, 5, 6.
- Niacin can improve control of triglyceride levels when other measures are inadequately effective 5, 6.
- Prescription omega-3 fatty acids have been approved by the United States Food and Drug Administration as an adjunct to diet for the treatment of very high triglyceride levels 7.