文摘
Background Omega-3 fatty acids are important in treatment of severe primary hypertriglyceridemia (HTG). In 15 patients with severe primary HTG (TG >500?mg/dl despite conventional TG lowering therapy), we assessed efficacy-safety of sequential monthly treatment with Lovaza, 4 to 8 to 12?g/day. Methods With TG >500?mg/dl despite Type V diet, hyperinsulinemia and diabetes control, and fibric acids, Lovaza (4?g/d) was added for 1?month, and if TG remained >500?mg/dl, increased to 8?g/d for 1?month, and then to 12?g/d for 1?month, and subsequently reduced to 4?g/day for 4?months. Results Primary HTG, median TG 884?mg/dl, 14 men, 1 woman, all white, age 50 ± 7?years, 12 non-diabetic, 3 with stable diabetes control. Weight and diet held stable throughout. In 5 patients, after 1, 2, and 3?months on 4?g/day, TG fell <500, mean 1390 to 234 (?3%, p<.0001), to 135 (?0%, p<.0001), and 158?mg/dl (?9%, p<.0001), with a negative TG slope, p=.0013. Non-HDLC fell from 320 to 177 (?5%, p=.001), to 152 (?3%, p=.0002), and to 163 (?9%, p=.0004), with a negative slope, p=.01. In 10 patients, with Lovaza increased from 4 to 8 to 12?g, 3 failed to respond. In 7 of these 10 patients, TG fell 37% from 1075 to 672 on 4?g (p=.006), to 577 on 8?g (?6%, p=.0009), and to 428?mg/dl (?0%, p<.0001) on 12?g/day, with a negative TG slope, p=.0018. TG on 12?g/day was lower than on 8?g/day, p =.03. Non-HDLC fell from 245 to 217?mg/dl (?1%) on 4?g/day, to 203 (?7%, p=.01) on 8?g/day, and to 192 (?2%, p=.003) on 12?g/day, with a negative slope, p=.016. Compared to pre-Lovaza baseline, no abnormal measures developed in safety tests. The 4, 8, and 12?g/d Lovaza doses were well tolerated. Conclusion Titration of Lovaza from 4 to 8 to 12?g/d safely offers an effective way to lower TG beyond conventional 4?g therapy.