Treatment
Management of Hypertriglyceridemia
����The initial treatment of mild-to-moderate hypertriglyceridemia should be
lifestyle therapy, including dietary counseling to achieve appropriate diet
composition, physical activity, and a program to achieve weight reduction
in overweight and obese individuals (1|������������).
����For severe and very severe hypertriglyceridemia (>1000 mg/dL), combine
reduction of dietary fat and simple carbohydrate intake with drug
treatment to reduce the risk of pancreatitis (1|������������).
����The treatment goal for patients with moderate hypertriglyceridemia is a
non-high-density lipoprotein (HDL) cholesterol level in agreement with
NCEP ATP guidelines (1|������������).
����Use a fibrate as a first-line agent for reduction of triglycerides in patients
at risk for triglyceride-induced pancreatitis (1|������������).
����Consider three drug classes (fibrates, niacin, n-3 fatty acids) alone or in
combination with statins as treatment options in patients with moderate to
severe triglyceride levels (2|������������).
����DO NOT use statins as monotherapy for severe or very severe
hypertriglyceridemia. However, statins may be useful for the treatment of
moderate hypertriglyceridemia when indicated to modify cardiovascular
risk (1|������������).
Fibrates
����Fibrates should be strongly considered in patients with severe and very
severe hypertriglyceridemia and should be considered in patients with
moderate hypertriglyceridemia. Fibrates decrease triglyceride levels by
30���50% and sometimes increase HDL cholesterol
����Fibric acid derivatives should be used with great caution in the setting
of renal insufficiency because the drugs are excreted in the urine and
may reversibly increase serum creatinine levels��� especially fenofibrate,
although the significance of this effect is unknown. Fenofibrate, which
does not interfere with statin metabolism and has a lower risk of causing
myopathy, is the preferred fibrate to use in combination with a statin. Due
to effects on protein binding, there is a potential interaction with warfarin
requiring careful monitoring.
����Gemfibrozil can be considered in very severe hypertriglyceridemia
beginning in the second trimester in pregnant women who are at risk of
pancreatitis.
