What is the primary treatment for very high triglycerides?

The primary treatment for very high triglycerides typically involves the use of fibrates. These medications are specifically designed to lower triglyceride levels in the bloodstream and are particularly effective when triglycerides are extremely elevated, often defined as levels greater than 500 mg/dL. Fibrates work by activating peroxisome proliferator-activated receptors (PPARs), which increase the oxidation of fatty acids and lead to a reduction in triglyceride production in the liver.

While other treatments like statins and omega-3 fatty acids can also help manage triglyceride levels, fibrates have a strong and direct effect in significantly reducing high triglyceride levels. Statins are primarily used for lowering LDL cholesterol and have a modest effect on triglycerides. Omega-3 fatty acids can also lower triglyceride levels, but fibrates are often considered first-line therapy for very high triglycerides due to their potency in this regard.

Bile acid sequestrants, although useful for lowering LDL cholesterol, do not have a significant effect on triglycerides and are not used as a primary treatment for this condition.