From the Guidelines
To lower triglycerides effectively, focus on lifestyle modifications including adopting a Mediterranean or low-carbohydrate diet, reducing sugar and refined carbohydrate intake, and limiting alcohol consumption, as recommended by the most recent guidelines 1. Regular exercise of at least 150 minutes per week of moderate-intensity activity can significantly reduce triglyceride levels, with studies showing a 10-20% reduction in triglycerides with combined physical activity and weight loss 1. Weight loss of even 5-10% of body weight can have substantial benefits, and increasing omega-3 fatty acids through fatty fish consumption (salmon, mackerel, sardines) twice weekly or supplements (1-4 grams daily of EPA/DHA) is also effective in reducing triglyceride levels 1. For those with very high triglycerides (>500 mg/dL), medications may be necessary, including prescription-strength omega-3 fatty acids (Vascepa or Lovaza, 2-4 grams daily), fibrates (fenofibrate 145 mg daily or gemfibrozil 600 mg twice daily), or niacin (1-2 grams daily), as recommended by the American College of Cardiology 1. Some key points to consider when managing hypertriglyceridemia include:
- Identifying and treating underlying causes of elevated triglycerides, such as lifestyle factors, secondary disorders, and triglyceride-raising drugs 1
- Using statin therapy to reduce ASCVD risk in patients with moderate hypertriglyceridemia, which can provide a 10-30% dose-dependent reduction in triglycerides 1
- Considering the use of fibrates, niacin, and n-3 fatty acids, alone or in combination, for patients with moderate to severe hypertriglyceridemia 1
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 LDL-C, Total-C, and the LDL-C/HDL-C ratio. Fenofibrate therapy also lowered triglycerides and raised HDL-C. The effects of fenofibrate on serum triglycerides were studied in two randomized, double-blind, placebo-controlled clinical trials of 147 hypertriglyceridemic patients.
The best way to lower triglycerides is by using fenofibrate or niacin.
- Fenofibrate has been shown to lower triglycerides by 28.9% to 54.5% in clinical trials 2.
- Niacin is indicated to reduce elevated TG in patients with primary hyperlipidemia and mixed dyslipidemia, and to reduce TG in adult patients with severe hypertriglyceridemia 3. It is essential to consult a healthcare professional to determine the most suitable treatment option.
From the Research
Lifestyle Changes
- Lifestyle modifications, such as improved diet and increased physical activity, are effective triglyceride (TG) lowering measures 4
- Lowering carbohydrate intake, especially refined carbohydrates, and increasing fat, especially omega-3 fatty acids, and protein intake can lower triglyceride levels 5
- Moderate- to high-intensity physical activity can lower triglyceride levels, as well as improve body composition and exercise capacity 5
- Cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control are also effective ways to lower TG levels 6
Pharmacological Treatment
- Statins are usually the first line of pharmacological treatment, although associated TG reductions are typically modest 4
- Fibrates are currently the drugs of choice for hypertriglyceridemia, frequently in combination with statins 4
- Omega-3 fatty acids can lower TG levels, with a daily dose of 2-4 g being effective 6
- Niacin can also improve control of triglyceride levels when other measures are inadequately effective 4
- High-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality in patients with high triglyceride levels and borderline or intermediate risk 5