Pharmacologic management of triglycerides. Discussion

Currently available cholesterol-lowering pharmacologic agents have been studied for their effect on reducing triglyceride levels. The fibrates increase lipoprotein lipase activity, thereby decreasing the size of triglyceride-rich particles. High doses of niacin can produce decreases in very low-density lipoprotein (VLDL) levels, triglyceride-rich particles, and low-density lipoprotein (LDL) by inhibiting hepatic lipoprotein synthesis. By increasing LDL-receptor activity, the statins increase the removal rate of triglyceride-rich particles. Each class of agents produces various degrees of triglyceride lowering, depending on the existing baseline level and other factors. Patients with elevated LDL who are also hypertriglyceridemic should receive statins as first-line therapy. Niacin may be used as an alternative first-line agent in patients with low LDL elevations. Combination therapy using other agents may be indicated depending on the patient's levels of triglycerides and LDL.