Lifestyle changes can lower high triglycerides
DEAR DOCTOR K:
I recently had my cholesterol checked, and it turns out I have high triglyceride levels. Why are high triglycerides dangerous? What can I do about it?
What's often called a "cholesterol test" really measures three different kinds of cholesterol and one other type of fat, triglycerides. Most people have heard of the three types of cholesterol: LDL ("bad") cholesterol, HDL ("good") cholesterol and total cholesterol. But not as many have heard of triglycerides.
Triglycerides are a type of fat that circulates in your blood. High triglycerides increase your risk for pancreatitis, or inflammation of the pancreas. They also increase your risk for heart disease and for stroke.
Here's how triglyceride levels are categorized:
-- Normal: less than 150 milligrams per deciliter (mg/dL)
-- Borderline high: 150 to 199 mg/dL
-- High: 200 to 499 mg/dL
-- Very high: 500 mg/dL and above
Triglyceride levels can be briefly raised by a recent fatty meal. So whenever cholesterol and triglycerides are measured, it is best if you have been fasting for 12 hours beforehand. Those levels that are called "high" above apply to the fasting state.
If you have elevated triglycerides -- even borderline high -- you should take steps to lower them. Start with lifestyle changes such as a healthy diet, exercise and weight control. Cutting back on sugar-sweetened foods and beverages can be especially effective.
If lifestyle changes fail, therapy will depend on the cause of your high triglycerides and their severity. For example, certain people have an inherited tendency for high triglycerides that does not, on its own, seem to increase the risk of heart disease. In this case, triglycerides levels may not need to be treated.
High triglyceride levels may also be caused by obesity or diets high in saturated fat. Illnesses such as diabetes, chronic kidney disease, underactive thyroid or liver disease can increase triglyceride levels. People who drink a lot of alcoholic beverages, even if they don't get liver disease, tend to have high triglycerides. Finally, certain medications can sometimes increase triglyceride levels: estrogen, tamoxifen, retinoid medicines, beta blockers, and medicines that suppress the immune system are examples.
High triglyceride levels can also be directly treated. Statins are commonly prescribed for lowering high levels of "bad" cholesterol, but they also effectively lower triglyceride levels. Another option is a triglyceride-lowering drug such as niacin or a fibrate. Fibrates such as gemfibrozil (Lopid) reduce the production of triglyceride in the liver. Moderate doses of a statin and a triglyceride-lowering drug may also be combined.
We have more information on triglycerides in our Special Health Report, "What to Do About High Cholesterol." (Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.)
For years, many doctors have focused on treating high levels of LDL ("bad") cholesterol and have tended not to treat elevated levels of triglycerides. Today there's good evidence that triglycerides should not be ignored.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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