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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 37

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