Pharmacological control of hypertriglyceridemia.

Hypertriglyceridemia has been recently recognized as a vascular risk factor, based on both clinical and experimental findings. Epidemiological studies clearly showed that elevated plasma triglycerides in subjects with low high-density lipoprotein (HDL) cholesterol (<35 mg/dl) and/or a low-density lipoprotein (LDL)/HDL cholesterol ratio > 5 are associated with an elevated risk for coronary heart disease (CHD), while intervention studies indicate that triglyceride lowering with drugs may lead to a significant CHD reduction. Elevated blood triglycerides are associated with major alterations in the structure/function of plasma lipoproteins, which become more atherogenic, and with abnormalities in the clotting system, which may predispose to coronary thrombosis. New criteria for the classification of hypertriglyceridemias and a stepwise approach to the management of patients with elevated plasma triglycerides have been recently developed. Nonpharmacological interventions, i.e., weight reduction, alcohol and smoking cessation, and physical exercise, are the first-line actions to control hypertriglyceridemia. Drug therapy should be considered when the nonpharmacological approaches are ineffective or inadequate. Fibric acid derivatives and nicotinic acid (and its derivatives) are the drugs of choice when treating hypertriglyceridemic patients; n-3 fatty acids (fish oil) and metformin (especially in diabetic patients) represent additional therapeutic agents.