Treatment of Hypertriglyceridemia Recommendations for Hypertriglyceridemia Referenced studies that support recommendations are summarized in online Data Supplement 13. COR LOE Recommendations In patients with ischemic stroke or TIA, with fasting triglycerides 135 to 499 mg/dL and LDL-C of 41 to 100 mg/dL, on moderate- or high-intensity statin therapy, with HbA1c <10%, and with no history of pancreatitis, AF, or severe heart failure, treatment with icosa- pent ethyl (IPE) 2 g twice a day is reasonable to reduce risk of recurrent stroke.219,220 In patients with severe hypertriglyceridemia (ie, fasting triglycerides 500 mg/dL [ 5.7 mmol/L]), it is reasonable to identify and address causes of hypertriglyceridemia and, if triglycerides are persistently elevated or increasing, to further reduce triglycerides in order to lower the risk of ASCVD events by implementation of a very low-fat diet, avoidance of refined carbohydrates and alcohol, consump- tion of omega-3 fatty acids, and, if necessary to prevent acute pancreatitis, fibrate therapy.221 223 Synopsis The categories of hypertriglyceridemia are mod- erate hypertriglyceridemia (fasting or nonfasting triglycerides 175 499 mg/dL [2.0 5.6 mmol/L]) and severe hypertriglyceridemia (fasting triglycerides 500 mg/dL [ 5.6 mmol/L]). In the former, excess triglycerides are carried in very-low-density lipopro- tein (VLDL). In the latter, most patients have elevated VLDL plus chylomicrons. VLDL are atherogenic, simi- lar to LDL. There are many causes of elevated VLDL, and it is reasonable to reduce their levels to reduce the risk of ASCVD. With severe hypertriglyceridemia, elevations of VLDL raise the risk of ASCVD, but as triglyceride levels increase, especially above 1000 mg/dL, increases in chylomicrons impart a risk of acute pancreatitis. In patients with ASCVD receiving recommended statin therapy, residual cardiovascu- lar risk is present. Elevated triglycerides are associ- ated with such risk. 