Pharmacologic management of triglycerides

Currently available cholesterol-lowering pharmacologic agents have been stu died for their effect on reducing triglyceride levels. The fibrates increas e lipoprotein lipase activity, thereby decreasing the size of triglyceride- rich particles. High doses of niacin can produce decreases in very low-dens ity lipoprotein (VLDL) levels, triglyceride-rich particles, and low-density lipoprotein (LDL) by inhibiting hepatic lipoprotein synthesis. By increasi ng LDL-receptor activity, the statins increase the removal rate of triglyce ride-rich particles. Each class of agents produces various degrees of trigl yceride lowering, depending on the existing baseline level and other factor s. Patients with elevated LDL who are also hypertriglyceridemic should rece ive statins as first-line therapy. Niacin may be used as an alternative fir st-line agent inpatients with low LDL elevations. Combination therapy using other agents may be indicated depending on the patient's levels of triglyc erides and LDL.