Triglycer ides How to Manage Patients with Elevated Triglycerides and When to Refer?

Hypertriglyceridemia (HTG) is among the most common dyslipidemias seen in clinical practice. Studies in recent years have demonstrated a causal relationship between triglyceride-rich lipoproteins (TRL) and cardiovascular disease (CVD). This is primarily due to enhanced atherogenicity of cholesterol-enriched remnants, the metabolic byproducts of TRLs. While desirable TGs are less than 150 mg/dL (fasting) or 175 mg/dL (nonfasting), optimal levels are likely to be less than 100 mg/dL. First line treatment for HTG is directed at lifestyle and includes weight loss. National guidelines recommend that adults aged 40-75 years with elevated triglycerides (175-499 mg/dL) and increased CVD risk (i.e., 7.5% or higher) have statins initiated or intensified after lifestyle and secondary factors are addressed. The recent results of the REDUCE-IT study also support consideration of Icosapent ethyl, the highly purified EPA, to further reduce CVD risk in high-risk patients with HTG.