How can I treat my high triglycerides?

Question

Hello doctor,

I had my lipid profile done last week, and my triglycerides are at 356 mg/dL, total cholesterol 228 mg/dL, LDL 145 mg/dL, and HDL only 32 mg/dL. I am 41, slightly overweight (BMI 29.8), and my HbA1c came back at 6.1 %.

I do not eat too much sugar, but I do have a lot of rice and fried foods. My doctor suggested starting Fenofibrate, but I am concerned about possible liver damage. My LFTs show SGPT 52 U/L (mildly high) and GGT 67 U/L.

Should I first try strict diet control and omega-3 supplements before starting medications?
Also, are there any advanced injectable options for lowering triglycerides faster?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

If triglycerides (TG) are more than 500 mg/dL, there is a risk of pancreatitis, and medication is almost always required immediately. If triglycerides are 200 to 499 mg/dL, it mainly indicates cardiovascular risk. First-line is lifestyle metabolic control unless already on maximum therapy or at very high risk.

You are at 356 mg/dL, not in the pancreatitis (inflammation of the pancreas) range, but clearly high and linked with low HDL (high-density lipoprotein), high LDL (low-density lipoprotein), prediabetes, and fatty liver.

So, a strict diet and exercise must be the foundation. A short trial of intensive lifestyle changes and omega-3 is reasonable before adding fenofibrate, unless the risk is urgent. Fenofibrate is generally safe, but it can cause transaminase elevations in some patients.

In your case, mildly raised ALT (alanine aminotransferase) and GGT (gamma-glutamyl transferase) are most likely from NAFLD (non-alcoholic fatty liver disease, which is the accumulation of excess fat in the liver), not drug-induced.

Fenofibrate can actually improve fatty liver in some cases, but LFTs (liver function tests) must be monitored every three months initially. Avoid alcohol and unnecessary hepatotoxic (harmful to the liver) agents.

There are injectables:

PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors (Alirocumab, Evolocumab) mainly lower LDL-C (low-density lipoprotein cholesterol) with modest TG lowering. It is very effective for LDL control if Statins are not enough or not tolerated.
Inclisiran is for LDL lowering, not a primary TG drug.
Volanesorsen is a very powerful TG-lowering agent used in rare genetic hypertriglyceridemias, not for you. It is not needed yet.
PCSK9 inhibitors are considered only if LDL remains high despite maximum Statin or Ezetimibe with lifestyle measures.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.