Management of Severely Elevated Triglycerides

Initial Assessment and Risk Stratification

• The American Diabetes Association recommends that for severely elevated triglycerides of 605 mg/dL, immediate implementation of intensive lifestyle modifications plus fibrate therapy is recommended to reduce the risk of acute pancreatitis 1, 2
• Triglyceride level of 605 mg/dL falls into the "severe hypertriglyceridemia" category, which carries a significant risk of acute pancreatitis and cardiovascular disease 2
• The primary goal for triglyceride levels ≥500 mg/dL is to reduce triglycerides to prevent acute pancreatitis 1, 2
• Evaluate for secondary causes of hypertriglyceridemia, including uncontrolled diabetes mellitus 2, 3, hypothyroidism 3, chronic kidney disease or nephrotic syndrome 1, and alcohol consumption 4, 3

First-Line Management

• The American Heart Association recommends complete abstinence from alcohol for patients with severely elevated triglycerides 4, 2
• Replace refined carbohydrates with unsaturated fats and protein 3, 2
• Initiate fibrate therapy (fenofibrate) as first-line medication for severe hypertriglyceridemia 2

Important Cautions

• The American College of Cardiology recommends that statin plus fibrate combination therapy has not been shown to improve cardiovascular disease outcomes and is generally not recommended due to increased risk of myositis 1, 3