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Recent Updates in Hypertriglyceridemia Management for Cardiovascular Disease Prevention

  • Coronary Heart Disease (S. Virani and M. Al Rifai, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Mounting evidence continues to support the causal role of triglyceride-rich lipoproteins (TRL) in the development of atherosclerotic cardiovascular disease (ASCVD). Substantial residual ASCVD risk remains among high-risk patients who have elevated triglycerides despite reduction in low-density lipoprotein cholesterol (LDL-C) with statin therapy. Ongoing research efforts have focused on evaluating triglyceride-lowering therapies among patients with hypertriglyceridemia.

Recent Findings

The REDUCE-IT trial showed that the addition of icosapent ethyl, a highly purified form of eicosapentaenoic acid (EPA), can reduce vascular events among statin-treated individuals with elevated triglycerides who have either clinical ASCVD or diabetes plus another risk factor. Although additional evidence for EPA has emerged from other trials, conflicting results have been reported by subsequent trials that tested different omega-3 fatty acid formulations. Randomized clinical trials have not demonstrated incremental ASCVD benefit of fibrates on background of statin therapy, but fibrates are used to help prevent pancreatitis in patients with severe hypertriglyceridemia. Selective inhibitors of apolipoprotein C-III (apoC3) and angiopoietin-like protein 3 (ANGPTL3), proteins that are involved in metabolism of TRLs by regulating lipoprotein lipase, have been tested in selected patient populations and showed significant reduction in triglyceride and LDL-C levels.

Summary

Statin therapy continues to be the cornerstone of pharmacologic reduction of cardiovascular risk. High-dose EPA in the form of icosapent ethyl has been demonstrated to have cardiovascular benefit on top of statins in persons with elevated triglycerides at high ASCVD risk. Ongoing clinical trials are evaluating novel selective therapies such as apoC3 and ANGPTL3 inhibitors.

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Funding

Dr. Michos is supported by the Amato Fund in Women’s Cardiovascular Health Research at Johns Hopkins University. Dr. Quispe is supported by a National Institutes of Health (NIH) T32 training grant (5T32HL007227).

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  1. Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524-C, Baltimore, MD, 21287, USA

    Renato Quispe, Ty Sweeney, Bhavya Varma & Erin D. Michos

  2. Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA

    Anandita Agarwala

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  1. Renato Quispe
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Correspondence to Erin D. Michos.

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Dr. Michos has served on advisory boards for Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Esperion, Novartis, Novo Nordisk, and Pfizer.

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Quispe, R., Sweeney, T., Varma, B. et al. Recent Updates in Hypertriglyceridemia Management for Cardiovascular Disease Prevention. Curr Atheroscler Rep 24, 767–778 (2022). https://doi.org/10.1007/s11883-022-01052-4

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