What are triglycerides?

From the Guidelines

To manage triglycerides and reduce the risk of cardiovascular disease, it is recommended to limit intake of refined carbohydrates and sugars, reduce alcohol consumption, increase physical activity to at least 150 minutes of moderate exercise weekly, and consume omega-3 fatty acids found in fatty fish like salmon, as supported by the 2020 guidelines on the management of blood cholesterol in diabetes 1.

Diagnosis and Management

The diagnosis of hypertriglyceridemia should be based on fasting serum triglyceride levels, with cutoffs defined by the Endocrine Society as 150 to 199 mg per dL for mild hypertriglyceridemia, 200 to 999 mg per dL for moderate, 1,000 to 1,999 mg per dL for severe, and 2,000 mg per dL or greater for very severe 1.

Treatment Options

For those with significantly elevated levels (above 500 mg/dL), medications such as fibrates (fenofibrate), omega-3 fatty acid supplements (4 grams daily), or statins may be prescribed, with the goal of reducing triglyceride levels and preventing pancreatitis, as recommended by the Endocrine Society 1.

Lifestyle Modifications

Weight loss of even 5-10% can dramatically reduce triglyceride levels, as excess triglycerides often result from consuming more calories than your body burns, and regular monitoring through lipid panel blood tests is important, especially if you have risk factors like obesity, diabetes, or a family history of high triglycerides. Some key points to consider:

• The 2018 guidelines recommend considering a persistently elevated triglyceride level as a factor favoring initiation or intensification of statin therapy in adults with moderate or severe hypertriglyceridemia and ASCVD risk ≥7.5% 1.
• The addition of high doses of a synthetic n-3 fatty acid preparation (icosapent ethyl) to statin therapy has been shown to reduce ASCVD events by 25% in patients with ASCVD and/or diabetes plus at least one other CVD risk factor, and with triglyceride levels 135–499 mg/dL and LDL-C levels 41–100 mg/dL 1.
• Patients with elevated fasting triglyceride levels should be evaluated for secondary causes of hyperlipidemia and treated accordingly, including excessive alcohol intake, untreated diabetes, endocrine conditions, renal or liver disease, pregnancy, autoimmune disorders, and use of certain medications 1.

From the FDA Drug Label

Fenofibrate tablets are indicated as adjunctive therapy to diet to reduce elevated low-density lipoprotein cholesterol (LDL-C), total cholesterol (Total-C), Triglycerides and apolipoprotein B (Apo B), and to increase high-density lipoprotein cholesterol (HDL-C) 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. Markedly elevated levels of serum triglycerides (e.g., > 2,000 mg/dL) may increase the risk of developing pancreatitis.

Fenofibrate is used to reduce triglycerides in patients with primary hypercholesterolemia or mixed dyslipidemia, and in patients with severe hypertriglyceridemia. The goal of treatment is to reduce the risk of pancreatitis associated with markedly elevated triglyceride levels. 2

• Key points:
  • Fenofibrate reduces triglycerides and increases HDL-C.
  • Fenofibrate is indicated for patients with primary hypercholesterolemia or mixed dyslipidemia, and for patients with severe hypertriglyceridemia.
  • Markedly elevated triglyceride levels may increase the risk of developing pancreatitis.

From the Research

Definition and Risks of Hypertriglyceridemia

• 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.
• Hypertriglyceridemia affects 15-20% of the adult population and is often discovered incidentally 4.

Risk Factors for Hypertriglyceridemia

• 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.
• Hypertriglyceridemia is also associated with overweight, metabolic syndrome, and diabetes mellitus 4.

Management of Hypertriglyceridemia

• Management of high triglyceride levels starts with dietary changes and physical activity to lower cardiovascular risk 3.
• Lowering carbohydrate intake (especially refined carbohydrates) and increasing fat (especially omega-3 fatty acids) 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 (5% to 7.4%) or intermediate (7.5% to 19.9%) risk 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.

Treatment Options for Hypertriglyceridemia

• Long-chain omega-3 fatty acids, fibrates, and niacin are therapeutic options in the treatment of hypertriglyceridemia 5.
• Prescription omega-3 fatty acids (P-OM3) and fenofibrate (FENO) are among the most effective lipid-altering agents that reduce TG levels 6.
• Concomitant use of P-OM3 or addition of P-OM3 to FENO can result in a TG reduction greater than that with FENO alone 6.
• Emerging therapies, including various biological agents, are being discussed for the treatment of hypertriglyceridemia 7.