Managing Hypertriglyceridemia and Other Lipid Disorders

Chicago-To manage dyslipidemia, hyperlipidemia, and hypertriglyceridemia, patients with type 2 diabetes typically take statin therapies such as pravastatin, simvastatin, and rosuvastatin. However, there are other options, including omega-3 fatty acids, niacin, and fenofibrate.

At the ADA meeting on Saturday night, several diabetes and lipids experts provided an overview of the diseases and discussed therapies in a satellite symposium titled Unpeeling Current Controversies of Lipid Management in T2DM: You Be The Judge. Amarin Pharma Inc., the marketer of Vascepa (icosapent ethyl), supported the session with an educational grant.

The FDA approved icosapent ethyl in July 2012 as an adjunct to diet and to reduce triglyceride levels in adults with severe hypertriglyceridemia (at least 500 mg/dL). The oral medication contains ethyl esters of eicosapentaenoic acid, an omega-3 fatty acid. Patients take two, 1-gram capsules twice daily with food.

Whereas icosapent ethyl is an FDA-approved prescription formulation of fish oils, over-the-counter (OTC) fish oils are not regulated by the FDA, according to Michael Miller, MD, a professor at the University of Maryland’s school of medicine. Thus, the OTC fish oils are not as reliable as icosapent ethyle, nor are they as potent.

Dr. Miller added that mixed hyperlipidemia is the most serious issue related to cardiometabolic risk. He also mentioned that having high levels of non-high-density lipoprotein (HDL) cholesterol is associated with high risk for cardiovascular disease and coronary heart disease. He defined non-HDL cholesterol as the combination of very-low-density lipoprotein, intermediate-density lipoprotein, low-density lipoprotein, and lipoprotein (a). He cited a study that found decreasing triglyceride levels below 150 mg/dL was associated with a lower risk of coronary heart disease regardless of a person’s low-density lipoprotein level.

Robert J. Chilton, DO, a professor of medicine at the University of Texas, agreed with Dr. Miller. He said that non-HDL cholesterol is a “very good measure” for determining hypertriglyceridemia and is covered by insurance companies. Robert H. Eckel, MD, a professor at the University of Colorado, said that measuring a person’s apolipoprotein B level is the preferred method, although it is not typically covered. However, he said that measuring non-HDL cholesterol is effective in identifying hypertriglyceridemia.