Focus on DIET and exercise for high triglycerides

you will see more focus on diet and exercise for high triglycerides and less reliance on prescribed (Rx) medications......
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

As a nutrition pharmacy specialist, you will see more focus on diet and exercise for high triglycerides and less reliance on prescribed (Rx) medications. This is different from current practice...

Fenofibrate (Lipanthyl, Fenolip, etc) use is increasing, despite the fact that there's no proof it improves cardiovascular outcomes. Regulators are also scrutinizing whether fenofibrate should be used with statins due to lack of benefit and possible adverse effects. Recommend focusing on lifestyle changes first. Explain that modest weight loss can drop triglycerides by 20%. Reducing added sugars, eliminating trans fats, increasing fibre and unsaturated fats, and limiting alcohol can drop it another 20% or more.

  • Consider suggesting fish oil (Omega Rx). A good rule of thumb is that 1 g/day of omega-3 fatty acids from fish oil lowers triglycerides by 5% to 10%. Recommend up to 4 g/day if tolerated.
  • Also check for medications that can increase triglycerides, such as oral estrogens, atypical antipsychotics, beta-blockers, and thiazides.
  • If LDL is also high, recommend a statin (e.g., atrovastatin 20 mg, etc) and explain that statins can also lower triglycerides by up to 30%. If non-HDL is high, recommend increasing the statin dose or adding niacin "NOT available in Egypt" or fish oil.
  • Calculate non-HDL by subtracting HDL from total cholesterol.
    • The goal for non-HDL is less than 130 mg/dL (3.5 mmol/L).
  • Try to save fenofibrate (Lipanthyl, Fenolip, etc) for when triglycerides are very high over 500 mg/dL (10 mmol/L or more). Fenofibrate can help lower triglycerides, but it might not improve cardiovascular outcomes.
  • Keep in mind that uncontrolled diabetes can also increase triglycerides. Recommend lowering blood glucose before going after high triglycerides.

NPS-adv

References

  1. Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011 May 24;123(20):2292-333.
  2. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001). Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA: The Journal of the American Medical Association, 285(19), pp.2486–2497.