Hypertriglyceridaemia
What is new?
The recommendation for the use of omega 3 polyunsaturated fatty acids from 2019 has changed in the Focused Update by now explicitly stating that only high-dose icosapent ethyl should be considered for high-risk or very high-risk patients with elevated triglyceride levels.
The rationale for this revision was the negative STRENGTH trial which failed to demonstrate benefit of a combined EPA and DHA preparation which is in contrast to the REDUCE-it trial which showed a reduction in cardiovascular events in high risk patients with TG levels of 1,5-5,6 mmol/L with icosapent ethyl which is a pure EPA compound.
Moreover there is a new recommendation for patients with severe hypertriglyceridaemia due to familial chylomicronaemia syndrome based on the results of the randomized placebo controlled APPROACH trial which showed a 77% decrease in TG levels and reduction of pancreatitis in FCS patients treated with Volanesorsen an antisense Oligoligonucleotide targeting apoC3.
This led to the recommendation that volenasoren should be considered in FCS patients with severe hypertriglyceridemia to lower triglyceride levels and reduce the risk of pancreatitis.
Recommendations
| Recommendations | Classa | Levelb |
| High-dose icosapent ethyl (2 x 2 g/day) should be considered in combination with a statin in high-risk or very high-risk patients with elevated triglyceride levels (fasting triglyceride level 135–499 mg/dL or 1.52–5.63 mmol/L) to reduce the risk of cardiovascular events.8,110 | IIa | B |
| Volanesorsen (300 mg/week) should be considered in patients with severe hypertriglyceridaemia (>750 mg/dL, >8.5 mmol/L) due to familial hylomicronaemia syndrome, to lower triglyceride levels and reduce the risk of pancreatitis.6,116 | IIa | B |
a Class of recommendation.
b Level of evidence.