Hypertriglyceridemia: Drug Therapy

Therapeutic target

Lowering triglycerides (TG) should reduce cardiovascular risk.

Therapy recommendations

  • Fibrates are first-line agents. Note: Fibrates may lower triglyceride levels but, in studies, there has been no clear evidence of efficacy in combination with statins.
  • Alternatively, nicotinic acid, omega-3 fatty acids (EPA, DHA), statins + nicotinic acid can be used. Note: The American Heart Association (AHA) has issued a scientific recommendation to treat patients with hypertriglyceridemia omega-3 fatty acids.
    • Omega-3 fatty acids (EPA, DHA) can reduce triglyceride levels by 25-30% when 1.5 g to 3 g of omega-3 fatty acids (EPA and DHA) are taken in a dose-dependent manner; a decrease in TG of up to 60% is possible when 5-6 g are taken.
  • See also under “Further therapy“.

Omega-3 fatty acids (EPA, DHA)

Active ingredient Dosage Special features
Omega-3 fatty acids Animal studies with fish oil or fish oil concentrates showed no evidence of fruit damaging effects.
  • Mode of action: Inhibition of synthesis and secretion of VLDL (very low density lipoproteins); by increasing lipoprotein lipase activity, increased triacylglycerides (triglycerides, TG) are removed from VLDL, thus promoting VLDL degradation. Furthermore, triglycerides are lipid-lowering (blood lipid-lowering), antithrombotic (effective against the formation of thrombi / blood clots), antiarrhythmic, antiatherogenic (atherosclerosis-inhibiting), weak antihypertensive (blood pressure-lowering) and anti-inflammatory anti-inflammatory.
  • For a good triglyceride-lowering effect, a total dose of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) of > 2 g/d is needed.
  • Indications: Hypertriglyceridemia
  • Dosage information: Daily intake of 1.5 g to 3 g of omega-3 fatty acids (EPA and DHA) can reduce TG levels by 25-30% in a dose-dependent manner. With an intake of 5-6 g, a decrease in TG up to 60% is possible.
  • Contraindications:
    • Disorders of fat digestion or fat emulsification in the small intestine, due to gallbladder or pancreatic diseases;
    • Acute and subacute pancreatitis (inflammation of the pancreas.
    • Acute pancreatic necrosis (ulcerated decay of pancreatic tissue due to “self-digestion” of the organ).
    • Acute to chronic liver intoxications,
    • Cirrhosis of the liver of any origin
    • Acute to chronic cholecystitis (gallbladder inflammation)
    • Gallbladder empyema (enlargement of the gallbladder due to obstruction of bile flow).
    • Blood clotting disorders
  • Side effects: At higher doses may occasionally nausea and belching. Possible smell or taste of fish.

Supplements (dietary supplements; vital substances)

Suitable dietary supplements should contain the following vital substances:

  • Fatty acids (omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)).