| Drug | Percentage reduction in serum triglycerides | Mechanism of action | Complications | Trials | ||||
| Fibrates | 20–50 | Increase LPL activity; PPARα activator; reduce VLDL secretion | Well tolerated with good safety profile; nausea; abnormal LFTs; some increased risk of rhabdo-myolysis in combination with statins; highly protein bound therefore risk of drug interactions | Helsinki Heart Study,118 FIELD,119 VA-HIT,120 BECAIT,121 BIP122 | ||||
| Nicotinic acid derivatives | 20–50 | Decrease VLDL and LDL production and release of FFAs from adipose tissue | Some worsening of glycaemic control and hyperuricaemia; flushing and pruritis; diarrhoea and hepatotoxicity when used at high doses | CDP,123 FATS,124 McKenney et al 125 | ||||
| Fish oil | 20–45 | Reduce VLDL production and increase peroxisomal β-oxidation | Minimal side effects with good safety record. | GISSI,126 JELIS127 | ||||
| High doses required, hence compliance may be a problem | ||||||||
| Statins at high dose | 7–45 reported though this is dependent on baseline triglycerides, and is <20% in most cases | HMG-CoA reductase inhibitor and enhance LDL receptor activity in the liver and hence increase VLDL and IDL removal | Well tolerated with good safety profile; abnormal LFTs; some increase in rhabdomyolysis in combination with some fibrates | 4S,128 Stein et al 129 130 |
FFA, free fatty acid; HMG-CoA, 3-hydroxy-3-methyl-glutaryl-CoA; IDL, intermediate density lipoprotein; LFT, liver function test; LDL, low density lipoprotein; LPL, lipoprotein lipase; PPARα, peroxisome proliferator-activated receptor α; VLDL, very low density lipoprotein.