Triglycerides - detailed study

Triglycerides: Why do they matter?

Triglycerides are an important measure of heart health. Here's why triglycerides matter — and what to do if your triglycerides are too high.

If you've been keeping an eye on your blood pressure and cholesterol levels, there's something else you might need to monitor: your triglycerides. Having a high level of triglycerides, a type of fat (lipid) in your blood, can increase your risk of heart disease.

However, the same lifestyle choices that promote overall health can help lower your triglycerides, too.

What are triglycerides?

Triglycerides are a type of fat (lipid) found in your blood. When you eat, your body converts any calories it doesn't need to use right away into triglycerides. The triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals. If you regularly eat more calories than you burn, particularly "easy" calories like carbohydrates and fats, you may have high triglycerides (hypertriglyceridemia).

What's considered normal?

A simple blood test can reveal whether your triglycerides fall into a healthy range.

• Normal — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L)
• Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)
• High — 200 to 499 mg/dL (2.3 to 5.6 mmol/L)
• Very high — 500 mg/dL or above (5.7 mmol/L or above)

Your doctor will usually check for high triglycerides as part of a cholesterol test (sometimes called a lipid panel or lipid profile). You'll have to fast for nine to 12 hours before blood can be drawn for an accurate triglyceride measurement.

What's the difference between triglycerides and cholesterol?

Triglycerides and cholesterol are separate types of lipids that circulate in your blood. Triglycerides store unused calories and provide your body with energy, and cholesterol is used to build cells and certain hormones. Because triglycerides and cholesterol can't dissolve in blood, they circulate throughout your body with the help of proteins that transport the lipids (lipoproteins).

Why do high triglycerides matter?

Although it's unclear how, high triglycerides may contribute to hardening of the arteries or thickening of the artery walls (atherosclerosis) — which increases the risk of stroke, heart attack and heart disease. Extremely high triglycerides — for example, levels above 1000 mg/dL (11.29 mmol/L) — can also cause acute pancreatitis.

High triglycerides are often a sign of other conditions that increase the risk of heart disease and stroke as well, including obesity and metabolic syndrome — a cluster of conditions that includes too much fat around the waist, high blood pressure, high triglycerides, high blood sugar and abnormal cholesterol levels.

Sometimes high triglycerides are a sign of poorly controlled type 2 diabetes, low levels of thyroid hormones (hypothyroidism), liver or kidney disease, or rare genetic conditions that affect how your body converts fat to energy. High triglycerides could also be a side effect of taking medications such as beta blockers, birth control pills, diuretics or steroids.

What's the best way to lower triglycerides?

Healthy lifestyle choices are key:

• Lose weight. If you're overweight, losing 5 to 10 pounds can help lower your triglycerides. Motivate yourself by focusing on the benefits of losing weight, such as more energy and improved health.
• Cut back on calories. Remember that extra calories are converted to triglycerides and stored as fat. Reducing your calories will reduce triglycerides.
• Avoid sugary and refined foods. Simple carbohydrates, such as sugar and foods made with white flour, can increase triglycerides.
• Choose healthier fats. Trade saturated fat found in meats for healthier monounsaturated fat found in plants, such as olive, peanut and canola oils. Substitute fish high in omega-3 fatty acids — such as mackerel and salmon — for red meat.
• Limit how much alcohol you drink. Alcohol is high in calories and sugar and has a particularly potent effect on triglycerides. Even small amounts of alcohol can raise triglyceride levels.
• Exercise regularly. Aim for at least 30 minutes of physical activity on most or all days of the week. Regular exercise can lower triglycerides and boost "good" cholesterol. Take a brisk daily walk, swim laps or join an exercise group. If you don't have time to exercise for 30 minutes, try squeezing it in 10 minutes at a time. Take a short walk, climb the stairs at work, or try some situps or pushups as you watch television.

What about medication?

If healthy lifestyle changes aren't enough to control high triglycerides, your doctor might recommend some of the following:

• Statins. Your doctor might prescribe these cholesterol-lowering drugs if you also have low high-density lipoprotein (HDL, or "good") cholesterol; high low-density lipoprotein (LDL, or "bad") cholesterol; or if you have a history of blocked arteries or diabetes. Examples include atorvastatin (Lipitor) and simvastatin (Zocor). Muscle pain is a potential side effect.
• Fish oils. Also known as omega-3 fatty acids, fish oil supplements can help lower your triglycerides. High doses are needed, however, so this option is often reserved for people who have triglyceride levels over 500 mg/dL (5.7 mmol/L).
• Fibrates. Fibrate medications, such as fenofibrate (TriCor, Fenoglide, others) and gemfibrozil (Lopid), also can lower your triglyceride levels. Fibrates seem to work best in people who have triglyceride levels over 500 mg/dL (5.7 mmol/L). Fibrates may increase the risk of side effects when taken together with statins.
• Niacin. Niacin, sometimes called nicotinic acid, can lower your triglycerides and your "bad" cholesterol (low-density lipoprotein, or LDL, cholesterol). It's typically reserved for people who have triglyceride levels over 500 mg/dL (5.7 mmol/L). Don't take over-the-counter niacin without talking to your doctor first. Niacin can interact with other medications and can cause significant side effects.

If your doctor prescribes medication to lower your triglycerides, take the medication as prescribed. And remember the significance of the healthy lifestyle changes you've made. Medications can help — but lifestyle matters, too.