Hypertriglyceridemia
- Treat secondary causes + alcohol/diet first
- TG ≥500: pancreatitis prevention matters
- Fibrate or prescription omega-3 often used
- Optimize diabetes + weight control
- Statin remains ASCVD foundation when indicated
- Icosapent ethyl lowers CV events in selected pts
- Very high TG → extremely low-fat diet
Use at a glance
- Treat secondary causes + alcohol/diet first
Choosing treatment
- Statin remains ASCVD foundation when indicated
Practical pearls
- TG ≥500: pancreatitis prevention matters
- Fibrate or prescription omega-3 often used
- Optimize diabetes + weight control
- Very high TG → extremely low-fat diet
Treatment selection
- Icosapent ethyl lowers CV events in selected pts
Key points
- 1st-line: diet, lifestyle, treat secondary causes
- LDL-C–lowering drugs ↓ ASCVD risk in hypertriglyceridemia; statins drugs of choice
- Above LDL-C goal on max-tolerated statin → add ezetimibe, bempedoic acid, and/or PCSK9i
- Severe HTG: fibrate, Rx omega-3, or olezarsen ↓ TG; only olezarsen proven ↓ pancreatitis
- FCS: olezarsen, plozasiran ↓ TG and pancreatitis risk
Nonpharmacologic therapies
- Dietary changes
- Lifestyle changes
- Treat secondary causes
Pearls
- Statins first-line below TG 1000 despite weaker TG lowering
- Lowering TG can raise LDL-C; recheck it
- ApoB predicts risk better than LDL-C here
- Omega-3s: more atrial fibrillation; DHA can raise LDL-C
Self-check
- What diet is used for very high triglycerides?
Extremely low-fat. - What remains the ASCVD foundation when indicated in hypertriglyceridemia?
A statin.
Drugs used for this (8)
All clinical uses · Open Hypertriglyceridemia in the interactive console ↗