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hypertriglyceridemia treatment

Answer

The treatment for hypertriglyceridemia involves a combination of lifestyle modifications and pharmacotherapy, tailored to the severity of the condition and the patient's overall cardiovascular risk.

Lifestyle modifications

Pharmacotherapy

  • Statins: Statins are recommended by various guidelines for the management of hypertriglyceridemia. The AAPA/ABC/ACC/ACPM/ADA/AGS/AHA/APhA/ASPC/PCNA 2019 guidelines suggest initiating statin therapy in 40–75-year-old adult patients with severe hypertriglyceridemia and ASCVD risk of ≥ 7.5% . The EAS/ESC 2020 guidelines recommend initiating statins as first-line therapy to reduce cardiovascular risk in high-risk patients with hypertriglyceridemia (triglyceride levels > 2.3 mmol/L; > 200 mg/dL)
  • Fibrates: The ES 2012 guidelines recommend initiating fibrates as first-line therapy to reduce triglycerides in patients at risk for triglyceride-induced pancreatitis . The EAS/ESC 2020 guidelines also suggest adding fenofibrate or bezafibrate to statins for primary prevention in patients with triglyceride levels of > 2.3 mmol/L (> 200 mg/dL) who have achieved their LDL-C goal
  • Omega-3 fatty acids: The ES 2020 guidelines suggest adding eicosapentaenoic acid ethyl ester to reduce the risk of cardiovascular disease in adult patients with moderate hypertriglyceridemia (> 150 mg/dL; > 1.7 mmol/L) on statins and with either ASCVD or diabetes plus two additional risk factors . The EAS/ESC 2020 guidelines also suggest adding n-3 polyunsaturated fatty acids (icosapent ethyl 2×2 g/day) in high- or very high-risk patients with triglyceride levels of 1.5–5.6 mmol/L (135–499 mg/dL) despite statin treatment

Novel therapies

In conclusion, the treatment of hypertriglyceridemia is multifaceted and should be individualized based on the patient's specific clinical context, including the severity of hypertriglyceridemia, the presence of comorbid conditions, and the patient's overall cardiovascular risk.

References

1

Hypertriglyceridemia

Medical management

Guidelines

Statins

Pathway
AAPA/.../PCNA 2019