Introduction: Elevated
triglyceride (TG) level is a prevalent condition in the general population and in patients with cardiovascular (CV) risk even under
statin therapy. Severe
hypertriglyceridemia (HTG) puts patients at risk for
acute pancreatitis. Several TG-lowering drugs failed in clinical trials, but subgroup analyses suggest that high-risk patients, such as those with atherogenic
dyslipidemia or diabetes, benefit from TG lowering.Areas covered: We review advances for TG-lowering drugs in clinical development. These include selective PPARĪ± modulators,
omega-3 fatty acid formulations that have been approved for severe HTG, and inhibitors of
apolipoprotein C-III, angiopoietin-like-3 or microsomal transfer
protein. Lessons learned from the success of the phase 3 trial REDUCE-IT with high-dose
icosapent ethyl are also reviewed.Expert opinion: We believe that TG-lowering
therapies are coming of age as they will allow to treat patients with high CV risk and moderate HTG, including T2D subjects, as well as patients with severe HTG or even
homozygous familial hypercholesterolemia, all of which being 'optimally' treated with a
statin. More studies on the impact of
therapy on quality of life in patients with severe HTG should be conducted with the help of patient registries.