USMLE Step 3 - Question 50

A 56 year old male with a history of obesity and poorly controlled diabetes mellitus presents for a routine clinic visit. He has no physical complaints. His lipid profile is below:

Total cholesterol 202 mg/dL

LDL 96 mg/dL

HDL 26 mg/dL

Triglycerides 452 mg/dL

Which of the following is the most appropriate therapeutic option at this time?

A. Start an HMG-CoA reductase inhibitor

B. Start gemfibrozil

C. Start niacin

D. Strict diabetic control

Elevated triglycerides can be from multiple different reasons which include poorly controlled diabetes mellitus, hypothyroidism, a non-fasting blood specimen, or simply hypertriglyceridemia. Treatment just like elevated LDL or low HDL starts with diet, exercise, and weight loss. In our patient’s case, controlling the diabetes will improve the triglyceride level significantly. Gemfibrozil is commonly used to treat hypertriglyceridemia if diet and lifestyle modifications are unsuccessful. HMG-CoA reductase inhibitors (statins) are not effective to lower triglyceride levels.