The landscape for severe hypertriglyceridemia (sHTG) is currently undergoing its most dramatic shift in decades.
Historically, sHTG has been underrecognized despite the serious risks, but today, advances in therapeutic innovation and scientific understanding are transforming the treatment paradigm.
Defined as triglycerides greater than or equal to 500 mg/dL, sHTG is characterized by an increased risk of acute pancreatitis, a serious and potentially life-threatening condition that can lead to prolonged hospitalization and organ failure.
As new therapies that reduce the risk of acute pancreatitis emerge and scientific evidence continues to evolve, the standard of care is shifting to improve outcomes and patient care.
Here are four trends that we believe are positioned to shape the future of sHTG management:
1. Earlier identification will become routine
As awareness of sHTG continues to grow, healthcare providers are recognizing the importance of identifying and managing sHTG early before serious complications occur. Similar to how healthcare providers do not wait for the patient’s first heart attack before aggressively treating high LDL cholesterol, there is increasing recognition amongst physicians that patients with sHTG should be treated proactively before the first acute pancreatitis episode.
Acute pancreatitis causes sudden and severe inflammation of the pancreas. A medical emergency, acute pancreatitis leads to debilitating pain, weeks in the intensive care unit or permanent organ damage. Just one attack can be fatal, and once a patient has experienced their first acute pancreatitis attack due to high triglycerides, the risk of recurrence increases. Reducing the risk of acute pancreatitis reinforces the importance of earlier and urgent intervention.
2. Patient care will be equally defined by clinical outcomes
For years, healthcare providers measured treatment success by lowering triglycerides below 500 mg/dL, the guideline-recommended threshold for acute pancreatitis risk. While this remains an important treatment goal, the future of sHTG care will be equally defined by clinical outcomes.
Reducing the risk of acute pancreatitis – especially for individuals who had a previous attack – and the physical and emotional burden of living with high triglycerides are increasingly becoming important measures of clinical success. Future management decisions will be guided by both lipid panel laboratory values and clinical outcomes.
3. Triglycerides will play a larger role in routine primary metabolic care
As the connections between triglycerides and metabolic health become more well understood, triglycerides are likely to receive greater attention as part of routine primary metabolic care. This shift is reflected in expert guidelines and recommendations, which emphasize the importance and urgent need to lower fasting triglyceride levels that are greater than 500 mg/dL to reduce associated risks, like acute pancreatitis.
Because sHTG is managed across multiple specialties such as cardiology and endocrinology, primary care providers will play an important role on the front lines of identifying patients with very high triglycerides and referring patients to specialists who can manage their specific case.
By identifying sHTG as part of routine metabolic care, primary care specialists will help to identify patients earlier, reducing time to treatment and the overall disease burden and improving patient outcomes.
4. Scientific innovation is expanding the possibilities of sHTG care
For decades, healthcare providers managed sHTG through lifestyle changes and traditional lipid-lowering therapies with modest results. Now, scientific advances are expanding the understanding of sHTG and creating new opportunities for treatment.
With more than 35 years of scientific leadership in RNA-targeted medicines, Ionis continues to help advance today’s understanding of triglyceride biology. In fact, Ionis was the first to discover apoC-III as a therapeutic target to reduce triglyceride levels – validating it first for familial chylomicronemia syndrome (FCS) and later for sHTG.
These scientific milestones are helping to redefine how sHTG is managed and to shape the broader treatment paradigm shift, with the ultimate goal of improving outcomes for patients.