How is hypertriglyceridemia (high triglyceride levels) managed in patients intolerant of statins, and what is the effect of combining omega-3 fatty acid with statins?

Updated: Jul 23, 2021
  • Author: Mary Ellen T Sweeney, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

It is recommended that patients intolerant to one statin (eg, owing to myalgias) try the other statins before excluding the entire class, particularly in secondary prevention of dyslipidemias. [45] If the patients cannot take statins other agents suitable for management of mixed dyslipidemia may be tried, either alone or in combination therapy, including niacin, fibric acids, and ezetimibe. [45] Bile acid sequestrants can raise triglycerides and are contraindicated in patients with very high triglycerides. [60]

Note the following [45] :

  • Statins are more effective when taken at bedtime or in the evening

  • Although lovastatin should be taken with food to maximize its absorption, the sustained-release formulation should be taken on an empty stomach

  • A major reduction in HDL may occur in some patients on combined therapy with fibrates and thiazolidinediones (check HDL levels 1-2 mo following initiation of this combination therapy)

  • Do not adjust dosing regimens more often than every 4 weeks after a fasting lipid panel has been obtained

A study by Jun et al found that treatment with omega-3 fatty acid and atorvastatin more effectively lowered triglyceride levels in patients than did atorvastatin therapy alone. The report involved adults with fasting triglyceride levels of 200 mg/dL or above but less than 500 mg/dL, and low-density lipoprotein (LDL) cholesterol levels of below 110 mg/dL. Patients underwent 8 weeks of daily treatment consisting of either 4000 mg of omega-3 fatty acid and atorvastatin calcium 20 mg or atorvastatin calcium 20 mg plus placebo. The report found that 62.9% of individuals in the omega-3/atorvastatin group achieved triglyceride levels of less than 200 mg/dL, compared with 22.3% of the monotherapy group. [86]


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