Answer 1 is incorrect. 7.93% chose this answer, “Omega-3 fatty acid.” Icosapent ethyl, a refined omega-3 fatty acid, is typically considered when triglycerides ≥ 500 mg/dL to help lower levels and reduce pancreatitis risk, but they are not typically first-line for triglycerides at 345 mg/dL. For individuals with known cardiovascular risk consideration of additional of Icosapent ethyl could be added after maximizing statin therapy.

Answer 2 is correct. 63% of you chose this answer, “Lifestyle modification (nutrition, physical activity, and weight management.” The first-line recommendation for triglycerides 150-499 mg/dL is lifestyle modification. This may include dietary modifications (types of fats, reducing added sugars, refined carbohydrates, and alcohol), increasing physical activity, and weight loss, if applicable. If triglycerides remain elevated or reach ≥ 500 mg/dL, pharmacologic treatment such as icosapent ethyl or fibrates may be considered to reduce the risk of pancreatitis.

Answer 3 is incorrect. About 10% of respondents chose this, “Start a Statin.” JT is already taking a statin, atorvastatin. Although we can consider maximizing statin therapy as LDL is above 70 mg/dl, this is not the best answer. Statins may have a modest triglyceride-lowering effect, they are not the primary treatment for hypertriglyceridemia at this level.

Finally, Answer 4 is incorrect. 18.41% chose this answer, “Start a Fenofibrate.” Fenofibrate are typically recommended when triglycerides elevate greater than 500 mg/dL to reduce pancreatitis risk and addition could be
considered if lifestyle therapy does not indicate benefit.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!