Importance of Reducing Triglycerides in FCS Care

Achieving profound triglyceride reductions is central to optimizing outcomes in familial chylomicronemia syndrome. In their exchange, Anthony Giamo, MD, and Nihar R. Desai, MD, emphasize that the American Heart Association defines severe hypertriglyceridemia as triglycerides ≥500 mg/dL and that lowering levels below this threshold is associated with substantial reduction in acute pancreatitis risk. The ability of APOC3‑targeted agents to bring a large proportion of patients below 500 mg/dL therefore represents a clinically meaningful advance.

Beyond hard clinical endpoints, the faculty highlight the impact of triglyceride control on daily functioning and psychosocial well‑being. Patients with FCS frequently live under strict dietary constraints that can preclude routine social activities, such as attending a restaurant meal or holiday gathering, for fear of precipitating pancreatitis. As triglycerides are better controlled with APOC3 inhibitors, clinicians may cautiously liberalize dietary restrictions, de‑escalate reliance on largely ineffective adjunctive agents (such as fibrates and omega‑3 fatty acids), and thereby improve quality of life while maintaining safety.

Desai notes that the consistent advantage seen for plozasiran in simulations—showing a greater proportion of patients crossing below the 500‑mg/dL threshold compared with olezarsen—may translate over time into fewer pancreatitis episodes, reduced medication burden, and better patient‑reported outcomes. Both experts stress the need for future research to quantify these benefits with rigorous clinical endpoints and validated quality‑of‑life measures. Nonetheless, current evidence supports aggressive triglyceride lowering with targeted therapies as a cornerstone of contemporary FCS management.