ÎÎTreatment of triglycerides and non-HDL-C is useful, including the
following:
• If triglycerides are 200-499 mg/dL, non-HDL-Ca should be less than 130 mg/
dL. (I-B)
• If triglycerides are greater than or equal to 500 mg/dLb, therapeutic options to
prevent pancreatitis are fibratec or niacind before LDL-lowering therapy. Treat
LDL-C to goal after triglyceride-lowering therapy, targeting a non-HDL-Ca
less than 130 mg/dL (ie, 30 mg/dL greater than LDL-C target) if possible.
(I-C)
ÎÎThe following lipid management strategies can be beneficial:
• Further reduction of LDL-C to less than 70 mg/dL is reasonable. (IIa-A)
• If baseline LDL cholesterol is 70-100 mg/dL, it is reasonable to treat LDL-C to
less than 70 mg/dL. (IIa-B)
• Further reduction of non-HDL-Ca to less than 100 mg/dL is reasonable.
If triglycerides are 200-499 mg/dL, the non-HDL-Ca target is less than
130 mg/dL. (IIa-B)
• Therapeutic options to reduce non-HDL-Ca (after LDL-C lowering) include
niacind or fibratec therapy.
• Nicotinic acid (niacin)d and fibric acid derivatives (fenofibrate, gemfibrozil)c
can be useful as therapeutic options (after LDL-C–lowering therapy) for
HDL-C less than 40 mg/dL. (IIa-B)
• Nicotinic acid (niacin)d and fibric acid derivatives (fenofibrate, gemfibrozil)c
can be useful as therapeutic options (after LDL-C–lowering therapy) for
triglycerides greater than 200 mg/dL. (IIa-B)
• The addition of plant stanol/sterols (2 g/d) and viscous fiber (>10 g/d) is
reasonable to further lower LDL-C. (IIa-A)
ÎÎEncouraging consumption of omega-3 fatty acids in the form of fish e
or in capsule form (1 g/d) for risk reduction may be reasonable. For
treatment of elevated triglycerides, higher doses (2-4 g/d) may be
used for risk reduction. (IIb-B)
a
Non-HDL-C = total cholesterol minus HDL-C.
Patients with very high triglycerides should not consume alcohol. The use of bile acid sequestrants
is relatively contraindicated when triglycerides are greater than 200 mg/dL.
c
The combination of high-dose statin plus fibrate can increase risk for severe myopathy. Statin doses
should be kept relatively low with this combination.
d
Dietary supplement niacin must not be used as a substitute for prescription niacin.
e
Pregnant and lactating women should limit their intake of fish to minimize exposure to
methylmercury.
b
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