Venous thromboembolism

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

Overview

Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the diet, as well as with niacin, fibrates and statins (three classes of drugs). Increased fish oil intake may substantially lower an individual's triglycerides.. Clinical practice guidelines by the National Cholesterol Education Program (NCEP) suggests that pharmacotherapy be considered with triglycerides are over 200 mg/dl. The guidelines state "the sum of LDL + VLDL cholesterol (termed non-HDL cholesterol [total cholesterol - HDL cholesterol]) as a secondary target of therapy in persons with high triglycerides (200 mg/dL). The goal for non-HDL cholesterol in persons with high serum triglycerides can be set at 30 mg/dL higher than that for LDL cholesterol on the premise that a VLDL cholesterol level 30 mg/dL is normal."

Drug therapy

Drug	Mechanism of benefit	Dosage	Formulation	Advantages	Side-effects	Contraindication
Niacin/Nicotinic acid	Reduces low density lipoprotein (LDL) (17-26%) Increases high density lipoprotein (HDL)	1.5 - 2 gm once daily	Crystalline Extended release form	Statin alone or combination therapy of niacin with statin are usually the first options in premature coronary artery disease. Decreases atherosclerosis in hypertriglyceridemia patients.	Flushing Pruritus Nausea Hepatitis (higher doses)	Hypersensitivity Hepatic disease
Omega-3 fatty acids	Decreases hepatic lipogenesis Increases plasma lipoprotein lipase activity. Increases hepatic mitochondrial and peroxisomal beta-oxidation Inhibition of acyl CoA:1,2-diacylglycerol acyltransferase enzyme EPAand DHA are poor enzyme substrates for triglyceride synthesis in liver & inhibits esterification of other fatty acids.	3 g/day of EPA and DHA is under FDA's "Generally Recognized As Safe" category. Higher doses increases risk of bleeding	Fatty fish (salmon,Herring), flaxseed, flaxseed oil, canola oil, soybean oil, and nuts. Capsule	Decreases very low-density lipoprotein VLDL , Decreases serum triglyceride by ≥ 50%	Bleeding at high doses Fishy smell, Can be reduced by Freezing of medication Trying different formulation Taking medication with food Nausea (approximately 4 % of individuals at < 3 gm/d, and 20% at > 4gm/d experiences git side-effects)	Hypersensitivity
Fibrate	Decreases triglyceride Decreases LDL	Gemfibrozil 600mg BD Fenofibrate 145 mg OD		Decreases non-fatal myocardial infarction No benefit on HDL levels, fatal coronary events or total mortality	Myositis Gallbladder stone	Hypersensitivity Hepatic disease End stage renal disease

To calculate the risk prediction click [3]

References

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