Management of Hypertriglyceridemia

Introduction to Treatment Guidelines

The American College of Cardiology recommends the addition of prescription omega-3 (icosapent ethyl 2-4 g per day) as the first-line treatment to reduce cardiovascular risk for patients with triglycerides at 4.63 mmol/L (approximately 410 mg/dL) already on atorvastatin 80 mg 1

A 5-10% reduction in body weight can decrease triglycerides by 20%, representing the most effective intervention 1
Restricting added sugars to <6% of total daily calories is recommended, as sugars directly increase hepatic production of triglycerides 1
Restricting total fat intake to 30-35% of total calories is recommended for moderate hypertriglyceridemia 1
At least 150 minutes per week of moderate-intensity aerobic activity can reduce triglycerides by approximately 11% 1

Icosapent ethyl (purified EPA) 2-4 g per day is indicated as adjunctive therapy to maximally tolerated statin for patients with triglycerides ≥150 mg/dL and established cardiovascular disease or diabetes with ≥2 additional risk factors 1
The REDUCE-IT trial demonstrated a 25% reduction in major cardiovascular events (number needed to treat = 21) 1
Fenofibrate 54-160 mg per day may be considered if triglycerides remain elevated >200 mg/dL after optimized lifestyle modifications and if cardiovascular risk is high 1
Fenofibrate reduces triglycerides by 30-50% 1
The combination of high-dose statin + fibrate increases the risk of severe myopathy, and statin doses should be kept relatively low with this combination 2, 3, 4

Regular monitoring of muscle symptoms and creatine kinase levels is obligatory, particularly in patients >65 years or with renal disease 1
The American Heart Association recommends surveillance of muscle symptoms and consideration of CPK levels if a fibrate is added 1

Non-HDL-C target <130 mg/dL (3.35 mmol/L) for patients with triglycerides 200-499 mg/dL 1
Significant reduction of triglycerides to decrease cardiovascular risk 1