高三酸甘油脂治療 TG levels between 150-885 mg/dL

參考資料: uptodate 

TG過高如果合併LDL超過目標值, 應使用 statin 治療. 

中高劑量 statin 例如 atorvastatin 80 mg qd 或 rosuvastatin 20-40 mg qd. 可以降低 TGs 25-30%, 在TG超過 800mg/dL 的患者甚至可以降 40% 

如果已經使用最大能忍受的statin劑量仍無法將LDL控制在目標值, 可加上 ezetimibe. 

高心血管疾病風險患者, 包括已經確診心血管疾病患者, 糖尿病患, 十年內發生心血管疾病機率>10% 的族群

高心血管疾病風險患者, 如果經過上述治療, TG仍超過 150, 可考慮加上 Fenofibrate 或 icosapent ethyl (或 niacin, 但較少用). 沒有胰臟炎病史的人, 可先服用魚油萃取物 icosapent ethyl, 如果曾有胰臟炎, 可選用 fenofibrate. 如果是高心血管疾病風險患者, 已經服用 fenofibrate, TG仍過高, 可再加上 icosapent ethyl 

icosapent ethyl=Vascepa= 魚油成份處方藥, 魚油中萃取高純度EPA(二十碳五烯酸)

The following is our initial approach to patients with TG levels between 150 and 885 mg/dL 

●All patients should adopt lifestyle modifications similar to those recommended for individuals at high risk of ASCVD . 
All patients not at their LDL-C goal should be treated with a statin.

Statins typically lower TG levels by 5 to 15 percent; however, high-intensity statin therapy can lower TGs by 25 to 30 percent in patients with fasting TGs <400 mg/dL. Larger reductions in TGs of 40 percent have been reported in patients with fasting TGs as high as 800 mg/dL with treatment with a moderate- to high-dose high-intensity statin (atorvastatin 80 mg daily, rosuvastatin 20 or 40 mg daily) [125,126]. Goals for the treatment of LDL-C are presented elsewhere.

●For patients who are not at LDL-C goal with maximally tolerated statin dose, we add ezetimibe.

●For patients with a TG level >150 mg/dL who have been managed with the above approach and who are at high risk of cardiovascular disease, we consider adding a drug that lowers non-HDL-C through effects of VLDL (eg, fenofibrate, icosapent ethyl, or rarely niacin) to further lower TG. High cardiovascular risk includes patients with known ASCVD or diabetes and those with a 10-year risk of a cardiovascular disease event >10 percent. 

For these high-risk patients we usually start with icosapent ethyl. However, if the patient has a history of pancreatitis, we might start with fenofibrate. If after adding either icosapent ethyl or fenofibrate the TG level remains >150 mg/dL, we consider adding the other drug based on clinical circumstances. For example, if the cardiovascular risk is high and we had started with fenofibrate, we consider adding icosapent ethyl.