What is the most appropriate action for a patient with severe hypertriglyceridemia according to ACC guidelines?

In patients with severe hypertriglyceridemia, the primary focus is on reducing triglyceride levels to prevent complications such as pancreatitis. According to the American College of Cardiology (ACC) guidelines, initiating a statin is considered the most appropriate action for managing severe hypertriglyceridemia. Statins are effective in lowering triglyceride levels and also provide cardiovascular benefits by reducing LDL cholesterol and overall cardiovascular risk.

While other medications like gemfibrozil, niacin, and fish oil can also lower triglycerides, they are not typically the first-line treatment according to the current guidelines. Gemfibrozil is known to interact negatively with statins, increasing the risk of myopathy and should not be used in combination with them. Niacin has fallen out of favor due to limited evidence for cardiovascular benefit when added to statin therapy and potential side effects. Fish oil supplements may reduce triglycerides but are generally considered as adjunctive therapy rather than primary treatment.

Thus, initiating a statin aligns with the recommendation for effectively managing severe hypertriglyceridemia while also addressing cardiovascular risk factors, making it the appropriate choice in this scenario.