Treatment of Hypertriglyceridemia
Non pharmacologic treatment
Non pharmacologic treatments are important in the therapy of hypertriglyceridemia.
Non pharmacologic approaches include the following:
Changing oral estrogen replacement to transdermal estrogen
- Decreasing alcohol intake
- Encouraging weight loss and exercise
- Controlling hyperglycemia in patients with DM
- Avoiding simple sugars and very high carbohydrate diets
- Pharmacologic treatment of isolated hypertriglyceridemia consists of a fibric acid derivative or niacin.
- Statins may be effective for patients with mild to moderate hypertriglyceridemia and concomitant LDL cholesterol elevation
Fibric Acid Derivatives
- Currently available fibric acid derivatives include Gemfibrozil: 600 mg PO bid before meals; Fenofibrate: typically 48 to 145 mg PO/d.
- Fib rates generally lower triglyceride levels 30% to 50% and increase HDL levels 10% to 35%. They can lower LDL levels by 5% to 25% in patients with normal triglyceride levels, but may actually increase LDL levels in patients with elevated triglyceride level.
- Common side effects include dyspepsia, abdominal pain, cholelithiasis, rash, and pruritus, fibrates may potentiate the effects of warfarin
- Gemfibrozil given in conjunction with statins may increase the risk of rhabdomyolysis.
Oincga-3 fatty acids
- Omega-3 fatty acids from fish oil can lower triglycerides in high doses
- The active ingredients arc eicnsapcntacnoic acid (EPA) and docosahexacnoic acid (DHA)
- To lower triglyceride levels, 1 to 6 g of EPA plus Dl 1A is needed daily.
- Main side effects are burping, bloating and diarrhea.
- A prescription form ofomega-3 acid fatty acids is available and is indicated for triglycerides over 500 mg/dL; four tablets contain about 3.6 g of omega-3 acid ethyl esters and can lower triglycerides by 30%.
- In practice, omega-3 fatty acids are being used as an adjunct to statin or other drugs in patients with moderately elevated triglyceride levels.
- The combination of omega-3 fatty acids plus statin has the advantage of avoiding the risk of myopathy seen in the statin fibrate combination.
Treatment of low HDL cholesterol
• Low HDL cholesterol often occurs in the setting of hypertriglyceridemia and metabolic syndrome. Management of accompanying high LDL cholesterol, hypertriglyceridemia, and the metabolic syndrome may result in improvement of HDL cholesterol
• Treatment specifically targeted at raising low HDL cholesterol levels may reduce the risk of cardiovascular events
• Non pharmacologic therapies are the mainstay of treatment including:
- Smoking cessation
- Weight loss