Figure 1. Management of Hypertriglyceridemia
Screen all adults every 5 years
Secondary Causes
↑ Fasting TGs
<1000 mg/dL ≥1000 mg/dL
CV Risk Family History
Treat
Lifestyle
• Diet
• Activity
• Weight Reduction
Drugs
• Fibrates (preferred)
• Niacin
• n-3 fatty acids
AND
GOAL
NCEP ATP
Consider
adding statins
Treat
Niacin
Î Clinical trials using niacin, alone or in combination with other lipid
medications, have shown benefits in decreasing cardiovascular event
rates and atherosclerosis.
Î The most common side effect is cutaneous flushing, which is most
significant with the first few doses. The most serious complication of
niacin therapy is dose dependent hepatotoxicity, and therapy should be
accompanied by monitoring of liver function tests. Other side effects of
niacin therapy include impairment or worsening of glucose tolerance and
hyperuricemia.
Î Niacin is contraindicated in patients with active peptic ulcer disease.
n-3 Fatty acids
Î The long-chain marine omega-3 fatty acids [eicosapentaenoic acid,
C20:5n-3 (EPA) and docosahexaenoic acid, C22:6n-3 (DHA)] lower fasting
and postprandial triglyceride levels in a dose-dependent fashion.
Î Side effects with large doses of omega-3 fatty acids include fishy taste
and burping.
