Which lipid-lowering agent is most effective at lowering triglyceride levels?

Fibrates are the most effective lipid-lowering agents for lowering triglyceride levels. They work primarily by activating peroxisome proliferator-activated receptors (PPARs), which enhance the breakdown of fatty acids and promote the conversion of triglycerides into energy. This mechanism leads to a significant reduction in triglyceride levels in the bloodstream.

Fibrates also have a modest effect on increasing high-density lipoprotein (HDL) cholesterol, which can provide additional cardiovascular benefits. Their action is particularly beneficial for patients who present with hypertriglyceridemia, as they target the primary abnormality effectively.

In contrast, statins, while effective at lowering low-density lipoprotein (LDL) cholesterol and having a modest effect on triglycerides, do not lower triglycerides as effectively as fibrates. PCSK9 inhibitors primarily work to increase LDL receptor activity and lower LDL cholesterol levels, with minimal direct effect on triglycerides. Bile acid sequestrants mainly lower LDL cholesterol levels and can have an inconclusive effect on triglycerides, often resulting in limited triglyceride reduction. Thus, the targeted action of fibrates on triglycerides makes them the preferred choice for managing elevated triglyceride levels.