If a patient has persistently elevated triglycerides despite statin therapy and lifestyle changes, what is a reasonable next step?

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When triglycerides stay high despite a statin and lifestyle changes, the next step is to add or intensify a therapy that specifically lowers triglycerides. Fibrates and high‑dose omega‑3 therapies (like icosapent ethyl) target TG reduction and have evidence of cardiovascular benefit in statin-treated patients with elevated TG. Fibrates work by activating PPAR‑alpha, reducing hepatic VLDL production and TG levels; fenofibrate is often preferred with statins due to a lower risk of muscle toxicity than some other fibrates. Icosapent ethyl provides not only TG lowering but also a proven reduction in cardiovascular events in high‑risk patients on statin therapy. So adding or increasing TG‑lowering treatment directly addresses the residual risk from elevated TG. Increasing statin dose to push TG down is not the right approach and carries more muscle toxicity risk, while stopping therapy or ignoring TG elevations leaves that risk unaddressed.