Scientists are excited about new medicines that work differently than old ones to lower triglycerides—a type of fat in your blood. When triglycerides get too high, people can develop pancreatitis (a painful pancreas problem) or heart disease. This review looks at three brand-new drugs that target a protein called apoC-III, which controls how your body handles triglycerides. These new medicines work much better than older treatments for people with very high triglyceride levels. While they’re proven to prevent pancreas attacks, doctors still need to study whether they help prevent heart disease.

The Quick Take

  • What they studied: How new medicines that block a protein called apoC-III can lower triglycerides (blood fats) and prevent serious health problems like pancreas inflammation and heart disease
  • Who participated: This is a review article that looked at research on people with familial chylomicronemia syndrome (a rare genetic condition causing very high triglycerides) and other people with dangerously high triglyceride levels
  • Key finding: Three new drugs—volanesorsen, olezarsen, and plozasiran—lower triglycerides much more effectively than older medicines, and they’ve been proven to prevent painful pancreas attacks in people with the rare genetic condition
  • What it means for you: If you have very high triglycerides that don’t respond to regular medicines, these new options might help prevent serious pancreas problems. However, it’s still unclear if they prevent heart disease, so talk to your doctor about whether you’re a good candidate for these treatments

The Research Details

This is a review article, meaning doctors and scientists read through all the existing research on new triglyceride-lowering medicines and summarized what they found. They looked at studies on three new drugs that work by blocking a protein called apoC-III, which normally prevents your body from clearing triglycerides from your blood. The researchers compared how well these three new medicines worked compared to each other and to older treatments like fibrates and fish oil supplements.

The scientists organized their findings by looking at what each medicine could do: how much it lowered triglycerides, whether it prevented pancreas attacks, and whether it helped prevent heart disease. They paid special attention to comparing the three new drugs side-by-side, even though they came from different studies, to see if one worked better than the others.

This type of review is helpful because it brings together information from many different studies so doctors can understand the big picture of how these new medicines work and what they can realistically do for patients.

Understanding how these new medicines work is important because older triglyceride-lowering drugs don’t work well enough for people with very high triglyceride levels. When triglycerides stay too high, people face serious risks like sudden pancreas inflammation (which is extremely painful and can be life-threatening) and heart disease. By reviewing all the current research together, doctors can better understand which patients should get these new medicines and what benefits they can expect.

This is a review article written by experts in the field, which means it summarizes existing research rather than conducting a new study. The strength of the conclusions depends on the quality of the studies being reviewed. The authors compared results across different studies, which helps show whether findings are consistent. However, because this isn’t a new research study itself, the findings are only as strong as the original research they reviewed. The fact that it was published in a respected medical journal (Current Atherosclerosis Reports) suggests it was reviewed by other experts for accuracy.

What the Results Show

The three new medicines—volanesorsen, olezarsen, and plozasiran—all significantly lower triglycerides in people with familial chylomicronemia syndrome, a rare genetic condition where triglycerides can reach dangerously high levels. These new drugs work much better than older medicines like fibrates and omega-3 supplements, which often don’t lower triglycerides enough in these patients.

Most importantly, all three new medicines have been proven to prevent acute pancreatitis (sudden, severe pancreas inflammation) in people with this genetic condition. This is a major breakthrough because pancreatitis is extremely painful and can be life-threatening. Before these medicines, people with this condition lived in fear of sudden attacks.

When researchers compared the three new drugs to each other, olezarsen and plozasiran appeared to work similarly well, both lowering triglycerides substantially. Volanesorsen also works well, though it may require more frequent injections. All three are given by injection rather than pills, which is different from older triglyceride medicines.

The review found that these new medicines work by blocking apoC-III, a protein that normally prevents your body from clearing triglycerides from the blood. By blocking this protein, the medicines help your body remove triglycerides more efficiently. This mechanism is different from how older medicines work, which explains why they’re more effective for severe cases. The medicines appear to be generally safe, though like all medicines, they can have side effects that need to be monitored. The review also notes that these medicines are now approved in different regions for treating familial chylomicronemia syndrome, showing that health authorities recognize their value.

Older triglyceride-lowering medicines like fibrates and fish oil supplements (omega-3 fatty acids) have been used for decades, but they don’t work well enough for people with very high triglyceride levels. These new medicines represent a major advance because they target the root cause (the apoC-III protein) rather than just trying to manage the symptom (high triglycerides). Previous research showed that high triglycerides increase the risk of both pancreatitis and heart disease, but older medicines couldn’t lower triglycerides enough to prevent these problems in severe cases. These new medicines finally provide an option for these difficult-to-treat patients.

This is a review article, not a new research study, so the conclusions depend on the quality of existing research. The review focuses mainly on familial chylomicronemia syndrome, a rare genetic condition, so we don’t yet know how well these medicines work for people with high triglycerides from other causes. Most importantly, while these medicines are proven to prevent pancreas attacks, the review found that their ability to prevent heart disease remains unproven—more research is needed. The medicines are very new and expensive, so long-term safety data is still being collected. Finally, because these are injection medicines, not everyone may be willing or able to use them regularly.

The Bottom Line

If you have familial chylomicronemia syndrome or very high triglycerides that don’t respond to standard medicines, ask your doctor about these new options (volanesorsen, olezarsen, or plozasiran). The evidence strongly supports using them to prevent pancreas attacks. However, don’t expect them to prevent heart disease yet—that benefit hasn’t been proven. These medicines should be used along with diet changes and other treatments your doctor recommends, not instead of them. Confidence level: High for preventing pancreas attacks; Low for preventing heart disease.

People with familial chylomicronemia syndrome (a rare genetic condition) should definitely discuss these medicines with their doctor. People with very high triglycerides that don’t improve with diet and standard medicines should also ask about them. People with normal or only mildly elevated triglycerides don’t need these medicines. If you have a family history of very high triglycerides or early heart disease, genetic testing might be worth discussing with your doctor.

If you start one of these medicines, you should see triglyceride levels drop within weeks. The benefit of preventing pancreas attacks should appear over months to years of treatment. However, it’s too early to know how long you need to take these medicines or what happens if you stop. This is something to discuss with your doctor as more long-term data becomes available.

Want to Apply This Research?

  • Track your triglyceride levels every 3 months (or as recommended by your doctor) and record any symptoms like abdominal pain, nausea, or digestive issues. Note when you take your medicine injections to ensure consistency.
  • If prescribed one of these medicines, set up a reminder system for your injection schedule (weekly or monthly depending on which medicine). Also track any dietary changes your doctor recommends, as diet remains important even with medicine. Log any side effects or concerns to discuss with your healthcare provider.
  • Create a health dashboard showing triglyceride trends over time, medicine adherence (did you take your injections on schedule?), and any pancreatitis symptoms. Share this data with your doctor at regular appointments to ensure the medicine is working as expected and to catch any problems early.

This review discusses new medicines that are still relatively new and are primarily approved for a rare genetic condition (familial chylomicronemia syndrome). These medicines are not appropriate for everyone with high triglycerides. Do not start, stop, or change any medicine without talking to your doctor first. While these medicines have been proven to prevent pancreas attacks in people with familial chylomicronemia, their ability to prevent heart disease has not yet been proven. This information is educational and should not replace medical advice from your healthcare provider. If you think you might benefit from these medicines, schedule an appointment with your doctor or a lipid specialist to discuss whether they’re right for you.