From the Guidelines
Triglyceride management should prioritize lifestyle modifications, including dietary changes and regular exercise, with medication considered for severely elevated levels (>500 mg/dL) to reduce the risk of cardiovascular disease and pancreatitis.
Key Considerations
- Normal triglyceride levels should be below 150 mg/dL, with levels above 200 mg/dL considered high 1.
- Lifestyle modifications, such as reducing intake of refined carbohydrates, sugars, and alcohol, and increasing consumption of omega-3 fatty acids from fish or supplements (1-4 grams daily), can significantly reduce triglyceride levels 1.
- Regular exercise (at least 150 minutes of moderate activity weekly) and weight loss of 5-10% if overweight are also crucial for managing elevated triglycerides 1.
- For severely elevated triglycerides (>500 mg/dL), medications such as fibrates (like fenofibrate 145mg daily), prescription omega-3 fatty acids (Vascepa or Lovaza, 2-4g daily), or statins may be necessary 1.
Management Strategies
- Initial treatment of patients with mild to moderate hypertriglyceridemia should include dietary counseling and weight loss in patients who are overweight or obese 1.
- Patients with primary hypertriglyceridemia should be evaluated for family history of dyslipidemia and cardiovascular disease, as well as other cardiovascular risk factors, such as central obesity, hypertension, abnormal glucose metabolism, and liver dysfunction 1.
- Secondary causes of hyperlipidemia, including excessive alcohol intake, untreated diabetes, endocrine conditions, renal or liver disease, pregnancy, autoimmune disorders, and use of certain medications, should be treated accordingly 1.
From the Research
Definition and Prevalence of Hypertriglyceridemia
- Hypertriglyceridemia is defined as fasting serum triglyceride levels of 150 mg per dL or higher 2
- It affects approximately 33% of the US population 3 and 15-20% of the adult population 4
- Hypertriglyceridemia is associated with increased risk of cardiovascular disease and pancreatitis 4, 2, 3, 5, 6
Risk Factors for Hypertriglyceridemia
- Common risk factors include obesity, metabolic syndrome, and type 2 diabetes mellitus 2
- Less common risk factors include excessive alcohol use, physical inactivity, being overweight, use of certain medications, and genetic disorders 2
- Elevated triglyceride levels are independently associated with cardiovascular disease risk 3
Management and Treatment of Hypertriglyceridemia
- Lifestyle modifications, such as dietary changes and physical activity, are the most effective ways to lower triglyceride levels 4, 2, 5, 6
- Statins can be considered for patients with high triglyceride levels who have borderline or intermediate risk of atherosclerotic cardiovascular disease 2, 5
- Fibrates, niacin, and long-chain omega-3 fatty acids can be used to lower triglyceride levels, especially in patients with severely elevated triglyceride levels 2, 3, 5, 6
- Icosapent ethyl esters (a purified EPA) have been shown to reduce cardiovascular risk in patients with elevated triglyceride levels and high cardiovascular risk 5
Role of Omega-3 Fatty Acids in Hypertriglyceridemia Management
- Omega-3 fatty acids, particularly EPA and DHA, have been shown to lower triglyceride levels and reduce cardiovascular risk 3, 5, 6
- Omega-3 supplements can significantly reduce the risk of sudden death, cardiac death, and myocardial infarction in patients with pre-existing cardiovascular disease 6
- Targeting resistant hypertriglyceridemia with omega-3 fatty acids may be a valuable resource in clinical management of cardiovascular risk 6