New clinical guidance from the American College of Cardiology recommends the addition of lifestyle intervention and/or pharmacological, non-statin management of those high-risk patients with persistent abnormal levels of elevated triglycerides known as hypertriglyceridemia, who are on lipid-lowering medications. The writing committee for this 2021 Expert Consensus Decision Pathway is made up of healthcare experts including two Baylor College of Medicine cardiologists.
Dr. Salim Virani, professor of medicine – cardiology at Baylor, and Dr. Christie Ballantyne, professor of medicine and chief of the section of cardiology at Baylor, are among a group of physicians who reviewed data from long term studies that looked at intervention methods and found that those with the highest risk of atherosclerotic cardiovascular disease (ASCVD) got the most benefit from further low-density lipoprotein cholesterol lowering with the addition of non-statin therapies.
“This document provides a comprehensive yet easy to follow guidance to clinicians on how to evaluate ASCVD risk associated with triglycerides, the role of lifestyle factors in the management of elevated triglycerides and when to use medications to maximize the benefit from triglyceride lowering,” said Virani, who is also a staff cardiologist at the Michael E. DeBakey Veterans Affairs Medical Center.
The guidance includes types of diet recommendations including when to include more of, restrict or abstain from certain foods such as fruits, sweetened beverages, as well as types of fats to consume for e.g. oily fish. In addition to adherence to a heart-healthy diet, regular physical activity, avoidance of tobacco products, limited alcohol consumption and maintenance of a healthy weight remains a critical component of ASCVD risk reduction, both before and while patients are using lipid-lowering medications.
Recommendations are also provided for clinicians and patients regarding the use of statins and triglyceride lowering non-statin therapies known to reduce the risk of ASCVD in patients with persistent hypertriglyceridemia who have established ASCVD, diabetes mellitus, severe hypertriglyceridemia and other high-risk factors. In addition to cardiovascular professionals, involvement of others members of the team including registered dietitians are recommended for patients with persistent hypertriglyceridemia so they can receive individualized nutrition guidance.
“We hope that better implementation of this decision pathway by clinicians will lead to better management of the increased risk of atherosclerotic cardiovascular disease risk associated with elevated triglycerides,” said Virani.
The “2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia” published in the Journal of the American College of Cardiology.
Since those with hypertriglyceridemia are at a higher risk of ASCVD and at the greatest risk for recurrent cardiovascular events such as heart attack or stroke, it is important to discuss any changes in treatment with your doctor.