Don't use fibrates for hypertriglyceridemia

[cbrsmurf]

http://www.ncbi.nlm.nih.gov/pubmed/22910758

 

Seems like a lot of providers are still unaware of this.  Use statins instead.

 

In fact, one should pretty much never use fibrates.  Most studies on fibrate use are very weak and the use of fibrates as an adjunct to any other lipid-lowering medication is questionable.

[peaceloveandPA]

What about fish oil for first line?! Especially in peds.

 

 

Let food be thy medicine

[UGoLong]

We use Lovaza (a very refined fish oil) for trigs>=500. Seems to work well.

[Joelseff]

http://www.ncbi.nlm.nih.gov/pubmed/22910758

 

Seems like a lot of providers are still unaware of this. Use statins instead.

 

In fact, one should pretty much never use fibrates. Most studies on fibrate use are very weak and the use of fibrates as an adjunct to any other lipid-lowering medication is questionable.

What about for pts with stating induced myositis? I have used fenofibrates for some of my stating sensitive pts and though I have to adjunctive therapy like welchol or lovaza, etc., I usually am able to manage them while decreasing their CK.

 

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[Joelseff]

What about for pts with stating induced myositis? I have used fenofibrates for some of my stating sensitive pts and though I have to adjunctive therapy like welchol or lovaza, etc., I usually am able to manage them while decreasing their CK.

 

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I meant statin. Stupid auto type on my phone

 

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[cbrsmurf]

Most of the studies DO show that fibrates lower triglycerides, but paroxidcally increases the risk of pancreatitis.  

 

Also, fish oil has also recently been shown to be of no benefit.

 

http://www.nejm.org/doi/full/10.1056/NEJMoa1203859

 

Although the Mediterranean Diet has demonstrated lowering of CVD in 2 big studies

[cbrsmurf]

What about for pts with stating induced myositis? I have used fenofibrates for some of my stating sensitive pts and though I have to adjunctive therapy like welchol or lovaza, etc., I usually am able to manage them while decreasing their CK.

 

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For my sensitive patients, I've had some success with pravastatin/Pravachol, which has the lowest rate of incidence of myalgia (fluvastatin has also low rates, but I've never used it).  I've also reduced to half of minimum doses qd or every other day and titrating up.  Rhabdo/myositis is supposedly very rare (1:30,000), so I don't think most pts who are complaining or leg/muscle pains are truly having it.  Evidence and results for statins are far, far stronger and greater than any of the other lipid-lowering agents - it's nearly equal to diet and exercise if I recall correctly.

[peaceloveandPA]

We use Lovaza (a very refined fish oil) for trigs>=500. Seems to work well.

You must have patients with good insurance! Haven't seen that covered by any insurance around here. Would love if it was.

 

 

Let food be thy medicine

[d2305]

Statins won't touch severe hyperlipidemia (which can cause pancreatitis). Fibrates will lower lipids to the point where you can measure the LDL.

[cupojava]

For my sensitive patients, I've had some success with pravastatin/Pravachol, which has the lowest rate of incidence of myalgia (fluvastatin has also low rates, but I've never used it).  I've also reduced to half of minimum doses qd or every other day and titrating up.  Rhabdo/myositis is supposedly very rare (1:30,000), so I don't think most pts who are complaining or leg/muscle pains are truly having it.  Evidence and results for statins are far, far stronger and greater than any of the other lipid-lowering agents - it's nearly equal to diet and exercise if I recall correctly.

Ditto. The bottom line is to decrease CV risks and statins are the only ones which have shown to do that. So if my pt can only tolerate statin (e.g. Crestor 20mg qweek since it is longer acting or Pravastatin 20mg QOD), then it's better than than treating just the numbers (meaning TGs). In addition, I have also used Enzyme coQ10 when pts develop some mild myalgia which incidentally has just shown to be effective with heart failure pts (Eutopean long term study published in May I think). If the pt's TGs are high, I'd be checking A1c.

[cinntsp]

Statins won't touch severe hyperlipidemia (which can cause pancreatitis). Fibrates will lower lipids to the point where you can measure the LDL.

 

You could order a direct LDL if available.