What medication is best for treating hypertriglyceridemia, especially when palmar xanthomas are present?

Fenofibrate is the most appropriate choice for treating hypertriglyceridemia, especially in the presence of palmar xanthomas. Palmar xanthomas are typically associated with significant elevations in triglyceride levels, often indicative of familial dyslipidemias such as type III hyperlipoproteinemia.

Fenofibrate is a fibrate that works by activating peroxisome proliferator-activated receptor alpha (PPAR-α), which increases the oxidation of fatty acids and promotes the clearance of triglyceride-rich lipoproteins. This action effectively lowers triglyceride levels, making fenofibrate a key medication in managing severe hypertriglyceridemia and associated complications like palmar xanthomas.

While atorvastatin, niacin, and omega-3 fatty acids can also lower triglyceride levels, they may not be as effective as fenofibrate for significant hypertriglyceridemia. Atorvastatin mainly works by reducing LDL cholesterol and may not have a substantial impact on triglycerides alone. Niacin can lower triglycerides but is less commonly used due to side effects. Omega-3 fatty acids can help reduce triglyceride levels as well, but their effect is generally considered less potent than that of fenofibrate,