Research Article 
Treatment options for the management of hypertriglyceridemia: Strategies based on the best-available evidence
Kevin C. Maki, Harold E. Bays and Mary R. Dicklin
Journal of Clinical Lipidology, 2012, 6(5), 413-426. DOI: 10.1016/j.jacl.2012.04.003
Abstract
A severe elevation in triglycerides (TG; ≥500 mg/dL) increases the risk for pancreatitis. TG levels ≥200 mg/dL are associated with a greater risk of atherosclerotic coronary heart disease (CHD). However, no outcomes trials exist to assess the efficacy of TG lowering for preventing pancreatitis in patients with severe hypertriglyceridemia. Similarly, no completed prospective outcomes trial exists to support or refute a reduction in CHD risk resulting from lipid-altering therapy in patients specifically selected for the presence of hypertriglyceridemia. This review examines the available evidence for the use of statins, omega-3 fatty acids, fibrates, and niacin in the management of hypertriglyceridemic patients. Results from CHD outcomes trials support statins as the first-line lipid-altering drug therapy to reduce CHD in hypercholesterolemic patients, and subgroup analyses suggest statins are efficacious in hypertriglyceridemic patients with fasting TG levels <500 mg/dL. Omega-3 fatty acids and fibrates are reasonable first drug options for patients with TG ≥500 mg/dL and often are used to lower TG levels with the objective of reducing pancreatitis risk, although a statin or niacin may also be reasonable options. Combination lipid drug therapy may be needed to achieve both low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol treatment goals for CHD prevention in patients with elevated TG levels, particularly those with TG ≥500 mg/dL. Additional clinical outcomes data are needed to provide a more evidence-based rationale for clinical lipid management of hypertriglyceridemic patients.
ASCI-ID: 2746-298
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Lipoprotein(a) particle concentration and lipoprotein(a) cholesterol assays yield discordant classification of patients into four physiologically discrete groupsJournal of Clinical Lipidology, 2012, 6(4), 368-373. DOI: 10.1016/j.jacl.2012.01.004
Hypertriglyceridemia and residual dyslipidemia in statin-treated, patients with diabetes at the highest risk for cardiovascular disease and achieving very-low low-density lipoprotein-cholesterol levelsJournal of Clinical Lipidology, 2012, 6(5), 434-442. DOI: 10.1016/j.jacl.2012.04.002
Icosapent ethyl, a pure EPA omega-3 fatty acid: Effects on lipoprotein particle concentration and size in patients with very high triglyceride levels (the MARINE study)Journal of Clinical Lipidology, 2012, 6(6), 565-572. DOI: 10.1016/j.jacl.2012.07.001
Relationships between alcohol intake and atherogenic indices in womenJournal of Clinical Lipidology, 2013, 7(5), 454-462. DOI: 10.1016/j.jacl.2013.03.009
Obesity, adiposity, and dyslipidemia: A consensus statement from the National Lipid AssociationJournal of Clinical Lipidology, 2013, 7(4), 304-383. DOI: 10.1016/j.jacl.2013.04.001
Prevalence of lipid abnormalities in the United States: The National Health and Nutrition Examination Survey 2003-2006Journal of Clinical Lipidology, 2012, 6(4), 325-330. DOI: 10.1016/j.jacl.2012.05.002
Risk of coronary heart disease is associated with triglycerides and high-density lipoprotein cholesterol in women and non-high-density lipoprotein cholesterol in menJournal of Clinical Lipidology, 2012, 6(4), 374-381. DOI: 10.1016/j.jacl.2012.02.011
Pseudohypertriglyceridemia: Two cases of probable glycerol kinase deficiencyJournal of Clinical Lipidology, 2012, 6(5), 469-473. DOI: 10.1016/j.jacl.2012.02.001
Omega-3 free fatty acids for the treatment of severe hypertriglyceridemia: The EpanoVa fOr Lowering Very high triglyceridEs (EVOLVE) trialJournal of Clinical Lipidology, 2014, 8(1), 94-106. DOI: 10.1016/j.jacl.2013.10.003
Prevalence of dyslipidemia and associated risk factors in Turkish adultsJournal of Clinical Lipidology, 2014, 8(2), 206-216. DOI: 10.1016/j.jacl.2013.12.011
Association between alcohol intake, overweight, and serum lipid levels and the risk analysis associated with the development of dyslipidemiaJournal of Clinical Lipidology, 2014, 8(3), 273-278. DOI: 10.1016/j.jacl.2014.02.003
Lipid abnormalities in foreign-born and US-born patients in a medical groupJournal of Clinical Lipidology, 2014, 8(1), 77-85. DOI: 10.1016/j.jacl.2013.10.007