Statin therapy reduces VLDL similarly to and statin trials include hypertriglyc- eridemic patients. Indeed, there is evidence to show that VLDL excess increases the patient s ASCVD risk and hence benefit from statin therapy.S4.5.2-6 Therefore, if an adult patient with moderate hyper- triglyceridemia has poorly controlled major risk fac- tors for ASCVD and a 10-year risk of ASCVD 7.5% by the PCE, it is reasonable to either initiate or inten- sify statin therapy. (See Section 4.4.2., Primary Prevention in Adults 40 to 75 Years of Age. )4. Most patients with triglycerides 500 mg/dL ( 5.6 mmol/L) have elevations of both VLDL and chylo- microns. Elevations of chylomicrons typically are present when triglycerides are 500 mg/dL ( 5.6 mmol/L), and chylomicronemia may cause acute pancreatitis. The higher the triglyceride level, the greater is the risk.S4.5.2-7 Patients with triglycerides range are at risk of developing unrecognized marked increases in triglycerides, leading to pan- creatitis. Most cases of severe hypertriglyceridemia have a genetic component, but secondary factors To prevent acute pan- creatitis, it is reasonable to reduce triglycerides whenever levels exceed 500 mg/dL (5.6 mmol/L). This reduction can be achieved by addressing and eliminating the underlying factors as described in Recommendations for Hypertriglyceridemia (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES Recommendation 1, implementing a very low- and adding fibrates or omega-3 fatty acids for patients with persistently elevated These are the most reliable pharmacological therapies to reduce triglycerides to a safer level. If a fibrate is neces- sary in a patient being treated with a statin, it is safer to use fenofibrate than gemfibrozil because of lower risk of severe myopathy.S4.5.2-16 Severe or life-threatening hypertriglyceridemia during preg- nancy is best managed in consultation with a lipid 4.5.3. 