What is considered the first-line treatment for very high levels of triglycerides?

Fibrates are recognized as the first-line treatment for very high levels of triglycerides due to their efficacy in significantly lowering triglyceride levels. They act primarily by activating peroxisome proliferator-activated receptors (PPARs), which enhance the oxidation of fatty acids in the liver and muscle, thereby reducing the liver's production of triglycerides. This mechanism leads to a decrease in triglyceride-rich lipoproteins, making fibrates particularly effective for hypertriglyceridemia.

In patients with extremely high triglyceride concentrations, fibrates may significantly reduce the risk of pancreatitis, a serious complication associated with very high triglyceride levels. While statins can lower triglycerides and are often used for overall lipid management, they are not as effective as fibrates for specifically tackling elevated triglycerides. Niacin can also lower triglycerides, but its use is more limited due to side effects and the availability of more effective options. Omega-3 fatty acids are beneficial for lowering triglycerides as well, but fibrates have a more established role as first-line therapy in cases of markedly high levels. Thus, fibrates remain the preferred choice in these clinical settings.