What is the first-line treatment for patients with very high triglycerides?

The first-line treatment for patients with very high triglycerides, particularly when levels exceed 500 mg/dL, is typically fibrates or omega-3 fatty acids. Fibrates, such as fenofibrate and gemfibrozil, are specifically designed to target triglyceride levels and have been shown to significantly lower triglycerides, reduce the risk of pancreatitis, and improve lipid profiles. Omega-3 fatty acids derived from fish oil are another effective option; they can lower triglycerides by decreasing hepatic triglyceride production and enhancing fatty acid oxidation.

While statins are highly effective in reducing LDL cholesterol and have some modest effects on triglyceride levels, they are not the first-line choice for very high triglyceride levels due to their primary mechanism of action focusing on LDL reduction. Bile acid sequestrants primarily target LDL cholesterol and are not effective for triglyceride management. Statin therapy alone, while beneficial for overall lipid control, does not specifically address very high triglyceride levels as effectively as fibrates or omega-3 fatty acids. Hence, fibrates or omega-3 fatty acids are preferred in these cases.