Treatment
Management of Hypertriglyceridemia
Î 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|⊕⊕
).
Î 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|⊕⊕⊕⊕).
Î The treatment goal for patients with moderate hypertriglyceridemia is a
non-high-density lipoprotein (HDL) cholesterol level in agreement with
NCEP ATP guidelines (1|⊕⊕
).
Î Use a fibrate as a first-line agent for reduction of triglycerides in patients
at risk for triglyceride-induced pancreatitis (1|⊕⊕⊕
).
Î 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|⊕⊕
).
Î 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
Î 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
Î 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.
Î Gemfibrozil can be considered in very severe hypertriglyceridemia
beginning in the second trimester in pregnant women who are at risk of
pancreatitis.
