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Current and Emerging Therapies for Atherosclerotic Cardiovascular Disease Risk Reduction in Hypertriglyceridemia
Reed Mszar1, Sarah Bart2, Alexander Sakers3
1Department of Physiology, Georgetown University, Washington, DC 20057, USA.
Insights
Hypertriglyceridemia (HTG) increases atherosclerotic cardiovascular disease (ASCVD) risk. New therapies show promise for lowering triglyceride (TG) levels, but access and policy changes are needed.
Area of Science:
- Cardiology
- Metabolic Diseases
- Pharmacology
Background:
- Hypertriglyceridemia (HTG) is common in patients with cardiometabolic risk factors.
- Elevated triglyceride (TG) levels are linked to increased atherosclerotic cardiovascular disease (ASCVD) risk.
- HTG is recognized as a risk-enhancing factor in clinical guidelines.
Purpose of the Study:
- To review current management strategies for HTG.
- To evaluate the efficacy of existing and novel therapeutics for HTG.
- To highlight the need for public health and policy interventions.
Main Methods:
- Literature review of current guidelines and therapeutic options for HTG.
- Analysis of evidence for lipid-lowering medications in ASCVD risk reduction.
- Discussion of emerging pharmacotherapies targeting apoC-III and ANGPTL3.
Main Results:
- Lifestyle interventions and statin therapy are recommended for mild to moderate HTG.
- Fibrates, omega-3 fatty acids, and niacin may benefit severe HTG but lack ASCVD risk reduction data in the statin era.
- Novel agents targeting apoC-III and ANGPTL3 demonstrate safety and efficacy in lowering TG levels.
Conclusions:
- Effective management of HTG requires a multi-faceted approach including lifestyle changes and pharmacotherapy.
- Emerging therapeutics offer new avenues for TG lowering.
- Urgent public health and policy strategies are necessary to improve access to care and treatment for HTG.
Abstract:
Hypertriglyceridemia (HTG) is a prevalent medical condition in patients with cardiometabolic risk factors and is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), if left undiagnosed and undertreated. Current guidelines identify HTG as a risk-enhancing factor and, as a result, recommend clinical evaluation and lifestyle-based interventions to address potential secondary causes of elevated triglyceride (TG) levels. For individuals with mild to moderate HTG at risk of ASCVD, statin therapy alone or in combination with other lipid-lowering medications known to decrease ASCVD risk are guideline-endorsed. In addition to lifestyle modifications, patients with severe HTG at risk of acute pancreatitis may benefit from fibrates, mixed formulation omega-3 fatty acids, and niacin; however, evidence does not support their use for ASCVD risk reduction in the contemporary statin era. Novel therapeutics including those that target apoC-III and ANGPTL3 have shown to be safe, well-tolerated, and effective for lowering TG levels. Given the growing burden of cardiometabolic disease and risk factors, public health and health policy strategies are urgently needed to enhance access to effective pharmacotherapies, affordable and nutritious food options, and timely health care services.
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