Statins are among the most frequently prescribed drugs globally, primarily aimed at managing blood fat levels to reduce the risk of heart disease and stroke. These drugs work by targeting the liver to modify the production and clearance of lipoproteins circulating in the bloodstream. While their main effect is on low-density lipoprotein (LDL) cholesterol, they also influence other lipids. Many people with elevated blood fats have high levels of triglycerides, a form of fat stored for energy. This article explores the relationship between statins and triglycerides, detailing how these medications work and what other treatments exist for high triglyceride levels.
The Primary Function of Statins
Statins work by blocking an enzyme in the liver called HMG-CoA reductase. This enzyme controls the rate-limiting step in the liver’s process for synthesizing cholesterol. By inhibiting this enzyme, statins effectively decrease the amount of cholesterol the liver produces internally.
The reduction in internally produced cholesterol creates a state of depletion within the liver cells. To compensate, the liver increases the number of LDL receptors on the surface of its cells. These receptors actively pull LDL particles out of the bloodstream to replenish the liver’s supply.
This mechanism makes statins effective at lowering LDL cholesterol, often referred to as “bad” cholesterol, with reductions reaching up to 60%. The primary purpose of these drugs is to reduce the concentration of circulating LDL particles, which are a major factor in the buildup of plaque within arteries.
How Statins Affect Triglyceride Levels
Statins demonstrably lower triglyceride levels, although this is generally considered a secondary effect to their action on LDL cholesterol. The amount of reduction is variable and depends significantly on the patient’s starting levels. For patients with high baseline triglyceride levels (above 250 mg/dL), statins can achieve a substantial reduction, sometimes ranging from 22% to 45%.
The mechanism behind this reduction is closely linked to the statins’ main action. By increasing the number of LDL receptors on the liver cell surface, statins enhance the clearance of all particles that carry apolipoprotein B (ApoB). This includes not only LDL but also very-low-density lipoprotein (VLDL), which is the primary carrier of triglycerides in the blood.
The removal of VLDL and its remnants from the circulation directly leads to a decrease in circulating triglycerides. Additionally, statins may reduce the liver’s production and secretion of VLDL particles. The statins most potent at lowering LDL, such as rosuvastatin and atorvastatin, also tend to exhibit the strongest effect on reducing triglycerides.
Non-Statin Treatments for High Triglycerides
When triglyceride levels are the main concern, or when they remain highly elevated (typically over 500 mg/dL) even with statin therapy, other treatments are often employed. The initial approach involves significant lifestyle changes, including dietary adjustments to reduce sugar and refined carbohydrates, which are efficiently converted into triglycerides by the body. Limiting or eliminating alcohol intake is also highly effective, as alcohol has a direct impact on raising triglyceride levels.
Pharmacological options beyond statins include several other classes of medication. Fibrates, such as fenofibrate and gemfibrozil, are often the drugs of choice for reducing very high triglycerides, achieving reductions between 25% and 50%. Fibrates work by activating a receptor that helps break down and clear triglyceride-rich particles from the blood.
High-dose prescription omega-3 fatty acids are another treatment option. These formulations, containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can lower triglycerides by 10% to 50% by decreasing the liver’s production of VLDL.
Niacin (Vitamin B3) is a third option that can decrease triglycerides by 20% to 50% and increase high-density lipoprotein (HDL) cholesterol. Its use is sometimes limited by side effects like skin flushing. These non-statin therapies are frequently used in combination with statins, especially in cases of mixed or severe hypertriglyceridemia.