If you have high cholesterol, there are clear steps you should take to lower it. But what should you do if your blood test shows that your triglycerides are elevated? High levels of triglycerides have been linked to an increased risk of heart disease and stroke.
A level appraisal
Synthesized by the liver, triglycerides are a type of fat that circulates in the blood and provides energy for the body. They are also found in the fats we eat. Blood levels rise temporarily after meals that contain fat, carbohydrates, or alcohol, and excess calories are stored as triglycerides in fat tissue.
A desirable blood level, measured after fasting, is less than 150 mg/dL (milligrams per deciliter of blood). Many experts think this cutoff should be 100. A level between 150 and 199 is defined as borderline-high; 200 to 500 is high; above 500 is considered very high.
Along with cholesterol, triglycerides tend to rise as people get older (and fatter); levels are lower in women than in men until menopause, after which they are similar until about age 60 and then a little higher.
Whether a high triglyceride level in and of itself endangers the heart is unclear, but there is growing evidence that high triglycerides contribute to cardiovascular disease. And they tend to go hand-in-hand with a constellation of other risk factors for heart disease, including increased levels of small dense particles of LDL (“bad”) cholesterol, insulin resistance or diabetes, abdominal obesity, and high blood pressure. Treating most of these conditions often brings triglycerides down, too—though not always.
High triglycerides are also associated with kidney disease, hypothyroidism, and the use of some medications, including certain diuretics, HIV drugs, birth control pills, and cortisone. They can also be related to genetics. Triglyceride levels above 1,000 can cause severe abdominal pain, usually after a meal, and increase the risk for pancreatitis, a potentially life-threatening inflammation of the pancreas.
A Triglycerides Research Roundup
High blood levels of triglycerides have been linked to an increased risk of heart disease, stroke, and other problems. Here’s just a sampling of some research findings from the past several years.
What it takes to lower triglycerides
If your triglycerides are high, your doctor will screen and treat you for any medical condition that could be contributing. Though it’s not clear whether lowering triglycerides improves cardiovascular risk, it’s prudent to do so, as these steps will also lower cholesterol and improve other coronary risk factors. And the good news is thattriglycerides are relatively easy to lower.
Depending on your levels and other risk factors, including your family history, your doctor may advise one or more of the following:
- Lifestyle changes, including losing weight if you’re overweight and limiting alcohol (even small amounts can raise triglycerides). Frequent moderate to intense exercise can help with weight loss and may also have a modest direct effect on triglycerides. People who exercise regularly experience a far smaller rise in triglycerides after meals than those who are sedentary. According to a Scientific Statement by the American Heart Association, published in Circulation in 2011, weight loss and exercise can reduce triglycerides by 20 to 50 percent.
- Dietary changes, including cutting sugars and other carbohydrates, especially fructose, as in high-fructose corn syrup and fruit juice. (Whole fruits in moderation are okay.) The same foods that can boost blood sugar most (such as sugars and some starchy foods) also boost triglycerides; in fact, these foods more consistently raise triglycerides than blood sugar. This doesn’t mean you need to go on a low-carb diet, but it helps to eat more unsaturated fats (in fish, nuts, seeds, vegetable oils, and avocados, for instance) in place of refined grains. And, as in any heart-healthy diet, you should focus on eating unsaturated fats in place of saturated fats and “good carbs,” including those in whole grains, beans, and vegetables. In the rare case of extremely high triglycerides (which is almost always genetic), a very low-fat diet is recommended, under guidance from a doctor or nutritionist.
- Fish oil, consisting of the omega-3 fatty acids EPA and DHA, lowers triglycerides as much as much as 50 percent (or more), depending on the dose and baseline levels. Lovaza is a prescription high-dose fish oil supplement, approved for treating people with triglycerides of at least 500 (though it can also raise LDL cholesterol). A newer prescription EPA-only drug is icosappent ethyl (Vascepa), which doesn’t appear to increase LDL. Over-the-counter fish oil supplements are generally considered safe, but you’d have to take more capsules to get the dose recommended for high triglycerides (two to four grams of EPA/DHA a day). Consult your doctor before taking such high doses of fish oil.
- Drugs may be prescribed to reduce triglycerides in people with very high levels. These include statins, which besides lowering cholesterol also reduce triglycerides by 20 to 40 percent. Older drugs called fibrates—such as fenofibrate (Tricor) and gemfibrozil (Lopid)—can lower triglycerides by 40 to 70 percent, especially in those with very high levels.
- The B-vitamin niacin, at high drug-like doses (up to 3 grams daily), lowers triglycerides by up to 40 percent (or more). However, as several large clinical trials have shown, this may not further improve cardiovascular risk in people with high triglycerides who are already taking stating. Further, niacin has potential severe adverse effects (including liver toxicity and a build up of uric acid, a waste product, in the blood). People with diabetes taking niacin should be monitored closely since it can worsen blood sugar control. According to a consensus statement from the European Atherosclerosis Society in 2011, high-risk peopleshould consider niacin (along with fibrates) if they have high triglycerides (above 150) and low HDL (below 40) and lifestyle interventions have not helped enough. Niacin can cause flushing of the skin; extended-release formulas minimize this effect.
Bottom line: Know your triglyceride level. It is important to lower it if it is elevated. Dietary and lifestyle changes are the first steps to take, but if these are not sufficient, or if your level is very high, you will need medical treatment.
Also see Cholesterol-Lowering Foods.
Published April 21, 2017