In a report published in the Journal of the American College of Cardiology, an expert consensus decision pathway (ECDP) was presented for the management of atherosclerotic cardiovascular disease (ASCVD) risk reduction in patients with persistent hypertriglyceridemia. The authors developed consensus recommendations for lifestyle intervention and pharmacologic management of high-risk patients with mild-to-moderate and severe hypertriglyceridemia. The ECDP relates to four populations of patients with persistent hypertriglyceridemia: those with established ASCVD, those with diabetes mellitus and additional risk factors, high-risk primary prevention patients, and those with severe hypertriglyceridemia. Factors to consider include evaluation and management of secondary causes, optimization of diet and lifestyle interventions, implementation of statin therapy and optimization of adherence, optimization of glycemic control, monitoring response to therapy and adherence, and conducting clinician–patient discussion of benefits, harms, and preferences. For management of all patients with persistent hypertriglyceridemia, lifestyle interventions are the first line of therapy; clinicians should begin with treatment of lifestyle factors, including overweight/ obesity, poor diet quality, sedentary lifestyle, and alcohol consumption. The authors emphasized that therapy should be individualized to target the lifestyle triggers thought to contribute most to hypertriglyceridemia.
