Hypertriglyceridemia management

Wong SF, Jakowatz JG, Taheri R. Management of hypertriglyceridemia in patients receiving interferon for malignant melanoma. Ann Pharmacother 2004 38 1655-9. 

Most patients with elevated LDL can be managed with a diet restricted in cholesterol and saturated fat but with sufficient calories to achieve and maintain ideal body weight. Total fat calories should be 20-25%, with saturated fats less than 8% and cholesterol less than 200 mg/d. Reductions in serum cholesterol range from 10% to 20% on this regimen. Use of complex carbohydrates and fiber is recommended, and monounsaturated fats should predominate within the fat allowance. Weight reduction and caloric restriction are especially important for patients with elevated VLDL and IDL. Those with hypertriglyceridemia should avoid alcohol. 

Answer D. Cholestyramine and colestipol are resins that sequester bile acids in the gut, preventing their reabsorption. This leads to release of their feedback inhibition of 7-alpha hydroxylase and the diversion of cholesterol toward new synthesis of bile acids. Increase in high-affinity LDL receptors on hepatocyte membranes decreases plasma LDL. These drugs have a small but significant effect to increase plasma HDL rather than decrease it, but their ability to increase TGs precludes their clinical use in the management of hypertriglyceridemias. 

Interest in fenofibrate has re-emerged with the near demise of gemfibrozil in some countries, once it became apparent that a statin+fenofibrate combination was highly likely to be safe. It is currently by far the preferred fibrate for the management of hypertriglyceridemia or in combination with a statin for treating combined hyperlipidemia. Different studies with a variety of statins have uniformly found no greater incidence of serious adverse reactions when fenofibrate is added compared with placebo. 

As shown in Table II and III (based on recommendations of N.I.H.)j the dietary management will be different for the two most frequent types of hyperlipoproteinaemias (II and IV) in which the abnormality, single or predominant, is hypercholesterolemia in the first and hypertriglyceridemia in the second case (48). 

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