Purpose of review 

In this review, we will summarize some of the landmark clinical trials of triglyceride-lowering therapies and review updates in clinical guidelines with regards to treatment of elevated triglyceride levels.

Recent findings 

Accumulating evidence from epidemiologic and Mendelian randomization studies has shown that triglyceride and are causally linked to atherosclerotic cardiovascular disease (ASCVD) and contribute to atherosclerosis. However, most clinical trials evaluating use of triglyceride-lowering therapies, including fibrates, niacin and fish oils [combined eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] have not been able to demonstrate significant cardiovascular risk reduction. REDUCE-IT is the only randomized clinical trial that showed significant cardiovascular benefit with the use of icosapent ethyl esters (a purified EPA), in patients with ASCVD or diabetes with elevated risk on maximally tolerate statin.

Summary 

Current guidelines and expert consensus documents from multiple societies strongly endorse therapeutic lifestyle interventions to effectively lower TG as the first-line therapy for treatment of hypertriglyceridemia. Evaluation and treatment of secondary causes of hypertriglyceridemia including optimal glycaemic control is crucial. Statins lower ASCVD risk in patients with elevated triglycerides and are first-line for treatment of elevated triglyceride. In a patient with residual mild to moderate hypertriglyceridemia on maximally tolerate statin and elevated cardiovascular risk icosapent, ethyl ester may be used for further ASCVD risk reduction.

中文翻译：

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甘油三酯指南中有哪些真正的新内容？

审查目的 

在这篇综述中，我们将总结一些具有里程碑意义的降低甘油三酯疗法的临床试验，并回顾有关甘油三酯水平升高治疗的临床指南的更新。

最近的发现 

流行病学和孟德尔随机研究的积累证据表明，甘油三酯与动脉粥样硬化性心血管疾病 (ASCVD) 存在因果关系，并导致动脉粥样硬化。然而，大多数评估使用降低甘油三酯疗法（包括贝特类、烟酸和鱼油[二十碳五烯酸 (EPA) 和二十二碳六烯酸 (DHA) 组合]）的临床试验未能证明显着降低心血管风险。REDUCE-IT 是唯一一项随机临床试验，显示使用二十碳五烯酸乙酯（一种纯化的 EPA）对最大耐受他汀类药物风险较高的 ASCVD 或糖尿病患者具有显着的心血管益处。

概括 

来自多个学会的当前指南和专家共识文件强烈支持治疗性生活方式干预，以有效降低甘油三酯作为治疗高甘油三酯血症的一线疗法。评估和治疗高甘油三酯血症的次要原因（包括最佳血糖控制）至关重要。他汀类药物可降低甘油三酯升高患者的 ASCVD 风险，是治疗甘油三酯升高的一线药物。对于最大耐受他汀类药物后残留轻度至中度高甘油三酯血症且二十碳五烯酸乙酯心血管风险升高的患者，乙酯可用于进一步降低 ASCVD 风险。