Severe IIa with statin or niacin concurrent low HDL cholesterol should be treated to reduce the risk of CHD. Treatment of hypertriglyceridemia independent of HDL levels may also be worthwhile to decrease the risk of ischemic cerebrovascular disease. Very high plasma triglycerides (>1000 mg/dL) are clearly a risk factor for pancreatitis and must be treated for this reason.
As with drugs that lower LDL cholesterol, dietary plus other lifestyle changes should accompany drug therapy of hypertriglyceridemia. Reduction of body weight to ideal is probably the single most important dietary goal. Because patients with familial hypertriglyc-eridemia may have increased liver capacity to synthesize fat from carbohydrate, attention should be given to restricting excessive carbohydrate and alcohol.
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