What is the primary treatment for hypertriglyceridemia?

The primary treatment for hypertriglyceridemia is fibrates. Fibrates, such as fenofibrate and gemfibrozil, are medications that effectively reduce triglyceride levels in the blood and are particularly effective in patients with elevated triglycerides. They work primarily by activating peroxisome proliferator-activated receptor alpha (PPAR-α), which leads to increased fatty acid oxidation, decreased triglyceride synthesis in the liver, and enhanced clearance of triglycerides from the bloodstream.

These agents can lower triglyceride levels by as much as 50%, making them a cornerstone in the management of patients with significant hypertriglyceridemia, especially when lifestyle modifications such as diet and exercise are insufficient. In addition to their triglyceride-lowering effects, fibrates can also modestly increase HDL cholesterol, the "good" cholesterol, providing additional cardiovascular protection.

While heparin and warfarin are anticoagulants used for different indications, they do not have a role in lowering triglyceride levels. Rimantadine is an antiviral medication used mainly for influenza and has no effect on triglyceride levels. Hence, fibrates are recognized as the primary therapeutic agents for managing hypertriglyceridemia effectively.