Management of Hypertriglyceridemia in Patients on Fenofibrate

Assessment and Discontinuation of Fenofibrate

For patients with normalized triglyceride levels, the American College of Cardiology suggests discontinuation of fenofibrate should be considered if there are no other compelling indications for continued therapy 1
Evaluate current triglyceride levels and response to fenofibrate therapy, considering discontinuation if triglycerides are within normal limits (<150 mg/dL) 1

If triglycerides are normalized, consider discontinuation of fenofibrate as the primary goal has been achieved, then check lipid panel in 6-12 weeks to ensure triglycerides remain controlled 1
The American College of Cardiology recommends reinforcing lifestyle modifications to maintain triglyceride control, including weight loss, dietary changes, and increased physical activity 3, 4

Weight loss of 5-10% can reduce triglycerides by up to 20%, according to the American College of Cardiology 3
Limit or eliminate alcohol consumption, as recommended by the American College of Cardiology 3
Reduce intake of simple and refined carbohydrates, especially sugar-sweetened beverages, as suggested by the American College of Cardiology 3
Increase physical activity to at least 150 minutes per week of moderate-intensity exercise, as recommended by the American College of Cardiology 3

In patients with diabetes and specific lipid patterns, the American Diabetes Association, as cited in Diabetes Care, suggests fenofibrate may provide additional benefit 2
For patients with ASCVD and elevated triglycerides despite statin therapy, the American College of Cardiology notes that icosapent ethyl has demonstrated cardiovascular benefit 2
Combination therapy with statins increases risk of myopathy, particularly with gemfibrozil, as reported in Diabetes Care and Praxis Medical Insights 1, 2