Endo Epa Ethyl Ester Statin Patients Tg 150 499

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name: endo-epa-ethyl-ester-statin-patients-tg-150-499
description: The guideline suggests adding eicosapentaenoic acid ethyl ester 4 g/day to reduce cardiovascular disease risk in adults on statins with persistent triglyceride levels 150–499 mg/dL who have either established atherosclerotic cardiovascular disease or type 2 diabetes plus ≥2 additional risk factors. Typical triggers are “Patient on statin with TG 150-499 mg/dL”, “Statin-treated patient with ASCVD or diabetes plus 2 risk factors”, and “Moderate hypertriglyceridemia despite statin therapy”.
---

# Adding EPA ethyl ester for statin-treated patients with moderate hypertriglyceridemia

## STEP 1 — Gather Information
Confirm the patient is on a statin, obtain a fasting triglyceride level, and assess for atherosclerotic cardiovascular disease (ASCVD) or type 2 diabetes plus ≥2 additional risk factors (e.g., hypertension, low HDL, smoking, family history of premature ASCVD, chronic kidney disease, metabolic syndrome).

## STEP 2 — Rule In / Rule Out
Is the triglyceride level >150 mg/dL and ≤499 mg/dL? If **yes**, proceed to STEP 3; if **no**, do not add EPA ethyl ester (consider other triglyceride‑lowering strategies).

## STEP 3 — Classify or Stratify
Does the patient have ASCVD **or** type 2 diabetes plus ≥2 risk factors? If **yes**, classify as a candidate for EPA ethyl ester; if **no**, do not add EPA ethyl ester.

## STEP 4 — Decide
Prescribe eicosapentaenoic acid ethyl ester 4 g/day.

## Clinical Guardrails / Mimics / Pitfalls
Do not use EPA ethyl ester if triglycerides are >500 mg/dL (consider fibrates or other agents); monitor for increased atrial fibrillation and bleeding events noted in REDUCE‑IT; if EPA ethyl ester is unavailable or inaccessible, a fibrate such as fenofibrate may be considered; benefit is independent of triglyceride reduction, so do not withhold based on on‑treatment TG levels.

## Concrete Clinical Example
A 58‑year‑old man on atorvastatin 40 mg daily presents with fasting TG 210 mg/dL, a prior myocardial infarction (ASCVD), and hypertension. He meets criteria for EPA ethyl ester; prescribe 4 g/day.

**Source:** Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2020, doi:10.1210/clinem/dgaa674
> **TODO:** consider adding scripts/calc.py for the endo-epa-ethyl-ester-statin-patients-tg-150-499 calculator