TG無用論，不用吃fenofibrate了，除非> 500mg/dl

不用管TG levels，除非高到>500

好好吃東西，好好運動，比吃藥重要!!

Don't Miss the New AHA Recommendations on Triglycerides

A new scientific statement raises the threshold for pharmacologic treatment of hypertriglyceridemia.

The following was published as a "Voices" blog on CardioExchange, an online forum for cardiology news and discussion. The blog prompted a lively conversation, which you can access and join by registering for CardioExchange.

I've been surprised at the lack of fanfare surrounding the American Heart Association's recently published scientific statement on triglycerides and cardiovascular disease (CVD). The attention it did receive focused on the lower fasting triglyceride level that is now considered optimal: <100 mg/dL. In my opinion, the real headline was the committee's important statements in support of less drug treatment — in particular, the recommendation for a substantial increase in the triglyceride level that should trigger consideration of pharmacologic therapy.

After a careful review of the recent literature, the committee concluded that pharmacologic therapy should not be started until a patient's fasting triglyceride level is 500 mg/dL (in contrast to the Adult Treatment Panel's recommendation of 200 mg/dL). See the figure, which also appears on page 2308 of the AHA statement.

The AHA committee also explicitly acknowledges (on page 2297) that "the independence of triglyceride level as a causal factor in promoting CVD remains debatable. Rather, triglyceride levels appear to provide unique information as a biomarker of risk, especially when combined with low HDL-C and elevated LDL-C." This clear statement — together with the new, higher threshold for initiating drug treatment — represents a remarkable change.

Meanwhile, on April 20, Abbott announced that sales of its flagship fenofibrate drugs increased by 28% in the first quarter.

Two questions:

• Why are doctors prescribing fibrates with growing enthusiasm when data from negative drug trials support an increasingly conservative approach to drug treatment?
• Given the new AHA recommendations, what should we do about all the people who were started on drug therapy to lower triglyceride levels that were less than 500 mg/dL?

I welcome your insights.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology July 13, 2011