DEAR DOCTOR K:
My recent cholesterol blood test came back pretty good, but my doctor said he was worried about my high triglyceride levels. What are triglycerides? Should I be worried, and what can I do about this?
When doctors perform cholesterol blood tests, they actually test for LDL (“bad”) cholesterol, HDL (“good”) cholesterol, total cholesterol (a combination of good and bad cholesterol), as well as triglycerides –another type of fat.
Levels of triglycerides that truly are high increase your risk for pancreatitis, an inflammation of the pancreas, as well as heart disease and stroke.
The level of triglycerides in your blood is measured accurately only when you’ve been fasting for 12 hours before your blood is drawn. When measured while you’ve been fasting, triglyceride levels are categorized in this way:
- 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.
Recent studies find that about a third of people in the United States have at least borderline high levels of triglycerides. Nearly 20 percent have levels that are clearly high. So this is an important health issue.
The advice I can give with confidence is to recommend lifestyle changes that we know can lower triglyceride levels. Avoid diets high in saturated fat. Cut back on sugar-sweetened foods and beverages. Exercise regularly, and achieve a healthy weight through a combination of diet and exercise. These lifestyle practices directly reduce the risk of heart disease and stroke, as well as reducing triglyceride levels. And reducing those levels may further reduce the risk of heart disease and stroke.
High triglyceride levels may also be caused by illnesses such as diabetes, chronic kidney disease, underactive thyroid or liver disease. Treatment of these diseases can also lower 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. If you are on any of these, ask your doctor if changing the dose or switching to another type of medicine is possible.
High triglyceride levels can be treated with medicines, too. The problem is that we don’t have proof that lowering triglyceride levels with drugs improves a person’s health. That’s because there has not been enough good research.
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 triglycerides in the liver. Moderate doses of a statin and a triglyceride-lowering drug may also be combined.
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.
(This column is an update of one that ran originally in September 2012.)