Which of the following agents is most effective in lowering triglycerides?

Fibrates are primarily designed to significantly lower triglyceride levels. They work by activating peroxisome proliferator-activated receptors (PPARs), which enhance fatty acid oxidation in the liver and muscle, leading to a reduction in triglyceride synthesis and an increase in the breakdown of triglycerides. This mechanism makes fibrates especially effective in addressing high triglyceride levels and is why they are often recommended for patients with elevated triglycerides that pose a risk for cardiovascular diseases.

In contrast, while statins primarily target low-density lipoprotein (LDL) cholesterol and can modestly lower triglyceride levels, their main action is not focused on triglyceride reduction. Niacin can also lower triglycerides and can raise high-density lipoprotein (HDL) cholesterol, but its effectiveness is less than that of fibrates when it comes specifically to triglycerides. Bile acid sequestrants primarily work to reduce LDL cholesterol and have minimal effects on triglycerides. Hence, fibrates stand out as the most potent option for directly lowering triglyceride levels.