RECENT FINDINGS: NHANES 2012 data has confirmed a reduction in average
triglyceride (TG) levels in the US population.
Dietary modification and
weight reduction when needed remain the core treatment elements for all individuals with HTG, while
statin therapy is a foundational pharmacologic care for atherosclerotic
cardiovascular disease (ASCVD) event risk reduction. In addition, the REDUCE-IT study provides evidence for additional benefit from the use of high-dose
icosapent ethyl (IPE) on top of background medical
therapy in adults with moderate HTG and ASCVD or
type 2 diabetes mellitus (T2D) and additional ASCVD risk factors. However, treatment with
eicosapentaenoic acid (EPA) combined with docosahexanoic
acid (DHA) did not reduce ASCVD in a similar population studied in the STRENGTH trial. Furthermore, novel
therapeutics targeting
PPAR-ɑ, as well as
ApoC-III and AngPTL3, effectively lower TG levels in individuals with moderate and severe HTG, respectively. These treatments may have applicability for reducing risk from ASCVD among individuals with chylomicronemia; in addition,
ApoC-III and AngPTL3 treatments may have a role in treating individuals with the rare monogenic
familial chylomicronemia syndrome (FCS) at risk for
acute pancreatitis (AP). Residual ASCVD risk in individuals treated with contemporary care may be due in part to non-
LDL lipid abnormalities including HTG. The findings from REDUCE-IT, but not STRENGTH, confirm that consumption of high-dose EPA may reduce ASCVD risk, while combination
therapy of EPA plus DHA does not reduce ASCVD in a similar population. TG lowering likely reduces ASCVD risk in individuals with HTG, but ASCVD risk is multifactorial; the added benefit of IPE to contemporary preventive
therapy is the consequence of differential non-TG
biologic properties between the two
fatty acids.
Acute pancreatitis is more difficult to study prospectively since it is less common; however, TG lowering is likely critical for the care of at-risk individuals. Additional benefit from novel
therapy that has an impact on this otherwise refractory condition is anticipated.