Most fats in the body exist as triglycerides. Hypertriglyceridemia, or a high triglyceride level, occurs when excessive amounts of triglycerides circulate in the body. This increases the risk of cardiovascular events and acute pancreatitis, or inflammation of the pancreas, which makes treatment of this condition very important. The National Cholesterol Education Program guidelines recommend drug therapy for the management of uncontrolled hypertriglyceridemia.
Fibrates
Fibrates, or fibric acid, include gemfibrosil and fenofibrate. In the May 2007 issue of "American Family Physician," Dr. Robert Oh reported that fibrates can markedly lower triglyceride levels by as much as 60 percent. Patients with moderately elevated triglyceride levels who use fibrates significantly decreased their risk of experiencing a cardiovascular event.
Adverse reactions of fibrate therapy include nausea, stomach upset, diarrhea and liver irritation. Monitoring should be done on all patients because liver irritation, though typically mild, can progress to liver failure if the use of this medication continues. Prolonged use of fibrates can also cause gallstones. Fibrates should never be used in patients with severe renal or liver disease.
Niacin
Niacin, also known as nicotinic acid, comes in both a prescription form and a dietary supplement. The National Cholesterol Education Program reports that use of the prescription form of nicotinic acid can lower triglyceride levels by up to 50 percent. Though not as potent as fibrates in lowering triglyceride levels, niacin offers the additional advantage of lowering LDL, or "bad" cholesterol, and raising HDL, or good cholesterol, levels.
Nicotinic acids can cause mild constipation. Some patients also experience flushing, or sudden redness of the skin. Contraindications to niacin use include gout and liver disease.
Fish Oil
Fish oil contains high amounts of essential omega-3 fatty acids, which are effective in decreasing triglyceride levels. Like niacin, fish oil comes in both prescription and over-the-counter forms. The prescription form of fish oil can lower triglycerides by 30 to 50 percent, as reported by Dr. Robert Oh. To date, no known contraindication exist with the use of fish oil. Side effects appear minimal, and include a fishy aftertaste and mild diarrhea. These effects usually subside as treatment continues.
HMG-CoA Reductase Inhibitors
HMG-Coa reductase inhibitors, also known as statins, include atorvastatin, lovastatin and simvastatin. Mainly prescribed to lower LDL cholesterol, they can also lower triglyceride levels. According to the National Cholesterol Education Program, statins can lower triglycerides by as much as 30 percent.
The most common side effects of statins include constipation, abdominal pain and cramping, all of which typically subside with continued use of the drug. Myopathy, defined as pain and tenderness of muscles, can also occur. Statins should not be given to patients who are pregnant, or those with active liver disease and statin allergy.
References
- National Cholesterol Education Program: ATP III At-A-Glance, Quick Desk Reference
- American Heart Assocatiation: Triglycerides
- Agency for Health Care Research and Quality: Screening for Lipid Disorders
- "American Family Physician;" Management of Hypertriglyceridemia; Dr. Robert C.Oh, et al.; May 2007
- Family Practice Notebook: Hypertriglyceridemia
