Triglycerides, The Less Famous Lipid
Most people are aware of low-density lipoprotein cholesterol (LDL-C), also known as the "bad" cholesterol. While treatment of LDL is generally the primary focus of people with "dyslipidemia" (abnormal lipids), there is another "bad" lipid as well. Known as triglycerides, these lipid particles are also important as high levels are considered a risk factor for coronary artery disease, heart attack, and stroke.
What is Triglyceride?
The words "cholesterol" and "lipid" may confuse people. Cholesterol (LDL and HDL — the "good" cholesterol) and triglycerides are all lipids, or fats, that are needed by your body, but in excess can lead to atherosclerosis (plaque buildup in your arteries). HDL cholesterol is the exception in that higher levels are desirable because HDL removes the bad cholesterol from your body.
Triglycerides are a form of fat, different from LDL cholesterol. Most of the fat that you eat is in the form of triglyceride. After you have eaten, the intestine processes the triglyceride and breaks them down. Some of the broken down particles are ultimately made into LDL by the liver while other particles (the fatty acids) are used for energy or reprocessed into triglycerides and stored in your body.
Elevated levels or triglycerides is called "hypertriglyceridemia." This is measured by a simple blood test, although it is important to be fasting for about 12 hours prior to the blood test. Triglyceride levels are much higher after eating. The goal for all people is < 150 mg/dL. Triglyceride levels can go very high — well over 1000 mg/dL. Patients with these levels are at risk for pancreatitis — an inflammation of the pancreas. Patients with diabetes and prediabetes generally tend to have higher levels than patients without diabetes.
Genetics and diet are the primary causes of high triglycerides, but there are some "secondary" causes of high triglycerides as well. These include kidney or liver disease and low thyroid levels. Some medications can also increase triglycerides, including estrogen replacement therapy, oral contraceptives, steroids, beta blockers, protease inhibitors (anti-retroviral therapy for patients with HIV), and some antipsychotic medications.
How is High Triglyceride Treated?
Triglycerides, even more than LDL, are very responsive to lifestyle modification and is always the "first line" for therapy. Most important is attaining a good body weight for your height, exercise, and diet. It is often helpful to have nutrition counseling to formulate a plan that is specific to your individual medical needs. Controlling your diabetes is also helpful. If lifestyle changes do not bring you to your goal, it is important to discuss options for treatment with your health care provider. There are several classes of medications that treat lipids. Those that specifically lower triglycerides are "fibrates" and fish oil with omega-3-fatty acids. Fibrates are a prescription medication; fish oil and omega-3-fatty acids are available in prescription formulations and also as supplements without a prescription. Drugs that target both LDL and triglycerides include the statin drugs and niacin. Many patients with diabetes also need to lower their LDL (goal is < 100 mg/dL) and may be on a combination of medications.
What Else Can You Do?
- Control of your lipids is very important. Make sure that you have an annual blood test to monitor your levels (more frequently if you are taking lipid medications).
- Keep your weight in check.
- Exercise regularly.
- Eat a heart-healthy diet.
- Speak with your health care provider if your triglyceride and lipid levels are not at goal.
Read Dr. Myerson's Bio here.
Read more of Dr. Myerson's columns.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
Fish Burgers Peanut Cucumber Salad Apple Spice Oat Cookies Spicy Cheddar Dip Barley Lentil Soup Spicy Seafood Stew Turkey Sausage Patties Burger Soup Artichoke Salad with Olives Greek Onion and Squash Pie
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...