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Hypertriglyceridaemia Prevention — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesHypertriglyceridaemia PreventionRACP Adult Medicine

A 50-year-old man with metabolic syndrome has fasting triglycerides of 12.5 mmol/L. He develops acute abdominal pain and a serum lipase of 1800 U/L. What is the specific long-term treatment to prevent recurrent hypertriglyceridaemia-induced pancreatitis?

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Correct answer: A — Omega-3 fatty acids alone

For severe hypertriglyceridaemia (>10 mmol/L) with pancreatitis, fibrates (fenofibrate 145 mg or gemfibrozil 600 mg BD) are the cornerstone of long-term triglyceride lowering to prevent recurrence. They activate PPARα, reducing VLDL production and enhancing lipoprotein lipase activity, lowering triglycerides by 30–50%. Dietary modification (very low-fat diet, alcohol avoidance), weight loss, and glycaemic control are essential adjuncts. Statins have modest triglyceride-lowering effects (~15–20%) and are insufficient as monotherapy for severe hypertriglyceridaemia.

Reference: eTG – 2025 – Cardiovascular; Endocrine Society – 2012 – Hypertriglyceridaemia Guidelines