High triglycerides, like high cholesterol, can increase the risk of cardiovascular disease and other health problems. But the good news is that this condition can be treated. Here’s how.
Doctors typically treat high triglycerides with lifestyle management and, if needed, medication.
Cholesterol gets all the attention, but doctors are interested in another number that makes up your blood lipid level: triglycerides. Triglycerides are a subgroup, or type, of our total cholesterol. In fact, the body has several lipoproteins that make up cholesterol, and triglycerides are one of them. Like low-density lipoprotein (LDL) cholesterol, triglycerides fall into the “bad” cholesterol category. In other words, total cholesterol is calculated by adding high-density lipoprotein cholesterol (HDL, or “good” cholesterol), LDL cholesterol and 20% of triglycerides. Doctors look at these numbers along with other risk factors: your family history, age, whether you smoke or have other health conditions, such as diabetes or high blood pressure, to determine your risk. heart attack or stroke.
When and why treat triglyceride levels?
Triglyceride levels are only part of the cardiovascular disease risk picture, and what’s “normal” may depend on your individual health factors. That said, the triglyceride guidelines are defined as follows:
Normal: Less than 150 mg/dL (milligrams per deciliter)
Upper limit: 150 mg/dL to 199 mg/dL
High: 200 to 499 mg/dL
Very high: 500 mg/dL and above
If you find yourself in a higher than normal category, your doctor will likely recommend lifestyle changes and possibly discuss medications to normalize your levels and reduce your risk of cardiovascular disease. A high level of triglycerides seems to lead to an increase in cardiovascular risk similar to that of LDL cholesterol. Triglycerides may play a role in the development of atherosclerosis, which is the buildup of plaques in the arteries that restrict blood flow and are associated with coronary heart disease, angina, and artery disease peripheral devices.
High triglycerides can often be a sign of other conditions that increase the risk of cardiovascular disease, such as obesity and metabolic syndrome, which is defined by the presence of three or more of the following conditions: excess abdominal fat , high blood pressure, high blood sugar, lower HDL cholesterol and, of course, high triglycerides. Extremely high triglycerides can lead to pancreatitis, which is inflammation of the pancreas.
The good news is that, like cholesterol, you can improve and manage high triglycerides with treatment. For the vast majority of people, we can make their triglyceride levels perfect by intervening with lifestyle changes and medication, which will reduce their risk of heart attack and stroke. Do not agree to leave your triglycerides high, and seek further help from a specialist if necessary.
Factors that Contribute to High Triglycerides
To assess which type of treatment is most appropriate for you, or if you need treatment at all, your doctor will first examine your blood lipid levels, paying attention to the ratio of triglycerides to total cholesterol, as well as as your personal and family history and existing risk factors.
For anyone age 20 or older who has triglyceride levels between 175 and 499 mg/dL, it would be best to first address the underlying medical causes that may be contributing to poor blood lipid levels. These causes include
type 2 diabetes
chronic liver disease
Chronic kidney disease
If one of these conditions has been diagnosed, your doctor can recommend specific management techniques, which may include several of the lifestyle changes mentioned below, as well as medication.
Certain medications, such as oral estrogen, beta-blockers, and some corticosteroids and osteoporosis medications, can also raise triglyceride levels. If one or more of your medications is contributing to your high triglycerides, it’s important to talk to your doctor about how your medications may affect you and what this means for your health. Your doctor might add a drug, switch drugs, or recommend changes to your diet to lower your levels. These changes often include reducing your intake of added sugar, simple carbohydrates, and high-fat foods and adopting a low-fat, whole-food diet.
Lifestyle management for high triglycerides
If your triglyceride levels are in the “high limit” category, it’s extremely likely that lifestyle improvements are enough to keep your levels in check. Most often, people with moderate levels have metabolic problems, including prediabetes and diabetes, which also respond well to lifestyle changes.
The following lifestyle changes can lower the rates:
Reduce your body weight
Reduce or avoid alcohol consumption
Increase your physical activity
Reduce your carbohydrate intake
Consume omega-3 fatty acids
Combining a low-carb diet with exercise and fish oil is often enough to keep triglycerides in check, and it can have the added benefit of addressing metabolic issues and reducing body weight. For the majority of people with moderate to severe elevations, triglyceride levels are very responsive to a heart-healthy lifestyle. It is worth trying to normalize the rate through these changes, and then switch to medication if the lifestyle is not enough.
Drugs for high triglycerides
If diet, exercise, and other lifestyle changes do not lower triglyceride levels enough, or if your doctor feels the level is too high to be treated with triglyceride interventions alone, life, he can recommend medication. Here are some commonly prescribed medications to lower triglycerides:
Statins are appropriate as a basic treatment for moderately or severely elevated triglyceride levels. These prescription medications help prevent cholesterol build-up in the liver, lower LDL cholesterol and triglycerides, and raise HDL cholesterol.
Omega-3 fatty acids
These essential nutrients are found in fish, flax seeds and other foods, as well as fish oil supplements. The three main omega-3 fatty acids are alpha-linolenic acid (ALA), found primarily in vegetable oils, such as flaxseed and canola, and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which is found in fish and other seafood. Numerous studies have shown that eating fish (salmon, mackerel, and tuna) and seafood rich in omega-3s can help you keep your heart healthy and reduce your risk of heart disease. And increasing your EPA and DHA intake through foods and supplements can help lower your triglycerides.
If you have very high triglycerides, your doctor may recommend that you take both fenofibrate and omega-3 fatty acids. Fenofibrate lowers both cholesterol and triglycerides and increases HDL cholesterol by speeding up the elimination of cholesterol from the body. However, unlike icosapent ethyl, fenofibrate has not been shown to reduce the risk of heart attack or stroke.
Niacin has been shown to lower LDL cholesterol and raise HDL cholesterol levels, and there is evidence that it can help lower triglycerides, but it can also cause unpleasant or even dangerous side effects ranging from stomach upset to high blood sugar, flushing and irregular heartbeat. Also, there is some evidence that niacin is not effective in preventing heart attacks or strokes in people who take it to prevent cardiovascular disease. Niacin lowers triglycerides, but is less potent than fish oil or fibrates, and has a poorer side effect profile. He prescribes it in rare cases, but cautions that only healthcare providers who specialize in cholesterol management should consider it for some patients.
The bottom line: High triglycerides, like high cholesterol, are a potentially serious health problem. But by making lifestyle changes and, if necessary, taking medication, most people will be able to successfully manage their condition and reduce their risk of cardiovascular disease.