The association between triglyceride levels and the risk of heart disease has been less clear than for cholesterol levels. However, newer studies have now established that people with elevated levels of triglycerides are indeed at increased risk.
Triglycerides are the most common form of fat in the body. In fact, almost all the excess calories you consume, whether from fats or carbohydrates, are converted to triglycerides and stored in your fatty tissues.
Triglycerides and Cardiovascular Risk
An elevated level of triglycerides in the blood - a condition referred to as hypertriglyceridemia - is associated with an increased risk of cardiovascular disease in both men and women. Furthermore, people with coronary artery disease (CAD) and elevated triglycerides have a higher risk of premature death than people with CAD and normal triglyceride levels.
What Are Considered High Triglyceride Levels?Triglyceride blood levels are classified as follows:
- Triglyceride levels less than 150 mg/dL are considered "desirable."
- Triglyceride Levels between 150 and 199 mg/dL are considered "borderline high."
- Triglyceride levels between 200 and 499 mg/dL are considered "high."
- Triglyceride levels at 500 mg/dL or greater are considered "very high."
In general, the higher your triglyceride level, the higher your cardiovascular risk. In addition, triglyceride levels in the "very high" range can cause pancreatitis, a painful and potentially dangerous inflammation of the pancreas.
What Causes Elevated Triglycerides?Elevated triglyceride levels can be related to your diet and your genetic makeup. In addition, high triglyceride levels can be produced by several medical conditions including:
- Diabetes and metabolic syndrome.
- Hypothyroidism (low thyroid).
- Certain types of kidney disease.
- Medications, including estrogen replacement, tamoxifen, and some beta blockers.
Treating High Triglyceride LevelsThe recommendations for treating hypertriglyceridemia are not as definitive as the recommendations for treating cholesterol. So if you have high triglyceride levels, you will need to discuss treatment options with your doctor.
The lack of definitive treatment recommendations stems from the fact that, while elevated levels of triglycerides have been associated with an increased risk of cardiovascular disease, evidence that you can reduce the risk by aggressively lowering triglyceride levels is lacking. Therefore, to a large extent the recommended treatments for elevated triglyceride levels aim less at reducing the triglyceride levels themselves, and more at reducing all cardiovascular risk factors, with special emphasis on LDL cholesterol.
However, there are some general guidelines for treating hypertriglyceridemia:
- For triglyceride levels in the borderline high range, lifestyle modification is recommended, including diet (avoiding saturated and trans fats, eating plenty of fruits and vegetables, and avoiding alcohol), weight loss, exercise, smoking cessation, control of blood sugar, and blood pressure control.
- For triglyceride levels in the high range, the same lifestyle modifications are recommended, along with reduction in LDL cholesterol levels according to the latest recommendations for treating LDL cholesterol.
- For triglyceride levels in the very high range, the primary goal is to prevent pancreatitis by reducing triglyceride levels to below 500 mg/dL (usually with a fibrate drug or niacin), then secondarily to aim for LDL cholesterol reduction according to the latest recommendations for treating LDL cholesterol.
Ford, ES, Li, C, Zhao, G, et al. Hypertriglyceridemia and its pharmacologic treatment among US adults. Arch Intern Med 2009; 169:572.
Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III): Final report. US Department of Health and Human Services; Public Health Service; National Institutes of Health; National Heart, Lung, and Blood Institute. Circulation 2002; 106:3143.