What is the recommended treatment for triglycerides above 500?

When triglyceride levels exceed 500 mg/dL, there is a significant risk for pancreatitis, a serious condition that requires effective management. Fibrates are the first-line pharmacological treatment options for hypertriglyceridemia in this range due to their ability to significantly lower triglyceride levels. They work by decreasing the liver's production of triglycerides and increasing the clearance of triglyceride-rich lipoproteins from the plasma.

While omega-3 fatty acids can also help lower triglyceride levels and may be beneficial in certain situations, they are typically considered adjunctive therapy for patients who still require further triglyceride reduction after fibrate treatment, or for those who cannot tolerate fibrates. Statins primarily target LDL cholesterol and have a modest effect on triglycerides but are not specifically indicated for triglyceride levels over 500. Exercise is an important lifestyle modification for overall cardiovascular health and can help improve lipid profiles, but it may not be sufficient as a standalone treatment for very high triglyceride levels, especially in urgent scenarios where rapid and more effective treatment is required.

Therefore, in the context of managing triglycerides above 500 mg/dL, fibrates are the preferred and recommended treatment option.