My ldl is 46 and triglycerides 540, i am taking simvastatin 40. do i need another chol med to target and fix my triglycerides.

It depends: Make sure your blood was drawn after fasting at least 12 hours. Nonfasting blood contains high triglyceride levels after a fatty meal. If triglycerides remain very high, your doctor might add a fibrate medication. If that is done, one must check your blood within the next few weeks to ensure you don't experience a rare adverse reaction called rhabdomyolysis, a muscle inflammation.

Next Steps: First, identify the problem. Possible causes include; genetic (familial combined hyperlipidemia, familial hypertriglyceridemia, familial dysbetalipoproteinemia); non-genetic (insulin resistance, type ii diabetes, thyroid abnormalities, chronic kidney disease, alcohol) issues. Next, optimize diet / exercise and fix contributing factors. Prescription fish oil (vascepa, lovasa) should be considered.

What is non-HDL?: Ldl is completely inaccurate (no matter how measured) when triglycerides are above 400 - and less accurate even when tg is above 200. The reason is that cholesterol moves from LDL to vldl particles where it can still cause damage. Best measure is total cholesterol minus HDL (called non-hdl), which if >160 needs extra treatment with a stronger statin or zetia (ezetimibe). Fish oil will help triglycerides.