What are the means to lower triglycerides (hypertriglyceridemia)?

From the Guidelines

To lower triglycerides, the most effective approach is to combine lifestyle modifications, such as weight loss, dietary changes, and increased physical activity, with medications if necessary, as recommended by the 2021 ACC expert consensus decision pathway 1.

Lifestyle Modifications

Lifestyle modifications are a crucial step in managing hypertriglyceridemia.

• Weight loss can lead to a reduction in triglyceride levels of up to 70% 1.
• Dietary modifications, including restricting or abstaining from alcohol, can result in a reduction of more than 70% in triglyceride levels 1.
• Physical activity and exercise can lead to a reduction of up to 30% in triglyceride levels 1.

Medications

If lifestyle modifications are not sufficient, medications may be prescribed to lower triglyceride levels.

• Fibrates, such as fenofibrate or gemfibrozil, can be effective in reducing triglyceride levels 1.
• Statins, such as atorvastatin, can provide a 10% to 30% dose-dependent reduction in triglycerides 1.
• Prescription omega-3 fatty acids, such as Vascepa or Lovaza, can also be effective in reducing triglyceride levels 1.

Monitoring and Target Levels

Regular monitoring of triglyceride levels is essential to assess the effectiveness of the treatment plan.

• The target level for triglycerides is below 150 mg/dL 1. By combining lifestyle modifications and medications, individuals can effectively lower their triglyceride levels and reduce their risk of cardiovascular disease.

From the FDA Drug Label

The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy. Physical exercise can be an important ancillary measure Fenofibrate tablets are indicated as adjunctive therapy to diet to reduce elevated ... Triglycerides

• Means to lower triglycerides include:
  • Dietary therapy
  • Addressing excess body weight and excess alcoholic intake
  • Physical exercise
  • Fenofibrate tablets as adjunctive therapy to diet 2 2 2

From the Research

Means to Lower Triglycerides

To lower triglycerides, several options are available, including:

• Therapeutic lifestyle interventions, such as diet and exercise, as the first-line therapy for treatment of hypertriglyceridemia 3
• Statins, which lower ASCVD risk in patients with elevated triglycerides and are first-line for treatment of elevated triglyceride 3
• Fibrates, niacin, and long-chain omega-3 fatty acids, which can be added if elevated triglyceride or non-high-density lipoprotein cholesterol levels persist despite the use of high-intensity statin therapy 4
• Icosapent ethyl ester, a purified EPA, which has been shown to reduce cardiovascular risk in patients with ASCVD or diabetes with elevated risk on maximally tolerated statin 3
• Combination of fenofibrate and niacin with lifestyle changes, which has been shown to improve dyslipidemia and hypoadiponectinemia in HIV patients on antiretroviral therapy 5
• Dietary measures, 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 6
• High-dose omega-3 fatty acids, which have been shown to lower triglyceride, reduce CVD, and prevent coronary plaque progression 6
• DHA supplementation, which has been shown to reduce blood triglycerides and increase lipoprotein lipase activity, whereas EPA supplementation may have a null effect on blood triglycerides due to concomitant increases in lipogenesis and LPL activity 7

Triglyceride-Lowering Agents

The following are some of the triglyceride-lowering agents that have been studied:

• Long-chain omega-3 fatty acids, which may be a well-tolerated and effective alternative to fibrates and niacin 4
• Fibrates, which improve triglycerides, total cholesterol, and non-HDL-C 5
• Niacin, which improves HDL-C and decreases the total cholesterol-to-HDL-C ratio 5
• Icosapent ethyl ester, which reduces cardiovascular risk in patients with ASCVD or diabetes with elevated risk on maximally tolerated statin 3
• DHA, which reduces blood triglycerides and increases lipoprotein lipase activity 7

Dietary Recommendations

The following dietary recommendations can help lower triglycerides:

• Minimize saturated fats and refined carbohydrates 6
• Eliminate trans-fat 6
• Increase fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 6
• Adhere to a Mediterranean diet, which has been shown to lower CVD and total mortality 6