- Triglycerides and High Cholesterol: Causes, Risks & Prevention
- How are triglycerides different from cholesterol?
- What are the guidelines for triglyceride levels?
- Is a high triglyceride level a health problem?
- How can triglycerides be lowered?
- Triglyceride Levels: High, Low & Normal Ranges
- LDL and HDL: What are triglycerides?
- How are triglyceride levels measured?
- What are normal triglyceride levels? What do elevated triglyceride levels mean?
- What causes low triglyceride levels?
- Changes in diet to lower triglycerides
- Cholesterol & Triglycerides: What You Need to Know
- Why Are Your Triglycerides Low? Link to LDL & HDL Levels
- Low Levels Are Usually Protective
- Low Levels May Be Associated With Worse Outcomes in Some Conditions
- What is Considered Low Triglycerides?
- High LDL-C
- High HDL-C
- 1) Genes
- 2) Ethnicity/Race
- Should you worry about high triglycerides?
- A sign of metabolic syndrome
- What you can do
- What is Cholesterol?
- Am I at Risk?
- High Cholesterol, Now What?
- Relation of High TG–Low HDL Cholesterol and LDL Cholesterol to the Incidence of Ischemic Heart Disease
Triglycerides and High Cholesterol: Causes, Risks & Prevention
Triglycerides are fats carried in the blood from the food we eat. Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body. Suggestions for lowering levels of triglycerides are presented.
Triglycerides are a type of fat, which come into your bloodstream three different ways:
How are triglycerides different from cholesterol?
Triglycerides and cholesterol are both types of fat in your blood known as lipids. Triglycerides provide much of the energy for cell function and metabolism of alcohol, and cholesterol is used to build cells and several hormones.
Your health care provider can check your cholesterol and triglyceride levels by taking a sample of blood. The blood is analyzed and provides triglyceride level, total cholesterol level, HDL cholesterol (high-density lipoprotein or “good” cholesterol) and LDL (low-density lipoprotein or “bad” cholesterol).
Following a meal, blood triglyceride levels are normally elevated. For an accurate reading, blood samples for a triglyceride test should be taken after a 12-hour period of not eating or drinking.
What are the guidelines for triglyceride levels?
Guidelines for triglyceride levels in healthy adults are:
- Normal: under 150 mg/dL
- Borderline high: 150-199 mg/dL
- High: 200-499 mg/dL
- Very high: 500 mg/dL or higher
Is a high triglyceride level a health problem?
Yes. Current research reveals elevated triglycerides may contribute to hardening the artery wall, which increases risk for stroke, heart attack, and heart disease. Often, high triglycerides are a sign of other conditions such as obesity, poorly controlled diabetes, low thyroid hormones, and liver or kidney disease.
How can triglycerides be lowered?
You may be able to reduce high triglycerides without medication by reducing sugar, alcohol, and fat intake, and following a low-fat, low-cholesterol diet. If you currently smoke, stopping may decrease your triglyceride level and your risk for heart disease. Weight loss may also decrease your triglyceride level and your risk for heart disease.
To reduce fat and cholesterol in your diet, here are some suggestions:
- Eat fewer calories if you are overweight. Excess calories are converted into triglycerides and stored as fat.
- Avoid refined foods and foods that contain sugar (such as white flour, desserts, candy, juices, fruit drinks, soda pop, and sweetened beverages).
- Choose carbohydrates that have 2 grams fiber or more per serving, such as brown rice, whole wheat bread, and whole grain cereals.
- Follow your doctor's advice regarding alcohol. Alcohol increases triglyceride levels for some individuals. If you have high triglycerides and do consume alcohol (such as red wine), it is recommended to limit intake to 5 ounces per day or limit it entirely.
- Decrease total amount of fat you eat to 20-35% of your total calories (
Triglyceride Levels: High, Low & Normal Ranges
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Diagram showing makeup of HDL and LDL cholesterol types measured by triglyceride tests
- Elevated triglyceride levels may be a risk factor for atherosclerosis. Highly elevated triglyceride levels may also cause fatty liver disease and pancreatitis.
- High triglyceride levels can also be associated with diabetes, kidney disease, and the use of some medications.
- Triglycerides are the main ingredient in vegetable oils and animal fats.
- The triglyceride test measures the level of triglycerides in the blood.
- Fasting for 9 to 12 hours before the triglyceride test is required.
- Normal triglyceride levels in the blood are less than 150 mg per deciliter (mg/dL).
- Triglyceride levels can be controlled to some extent by lifestyle modifications and, when necessary, medications.
Triglycerides can be lowered without drugs. For example, they can be lowered naturally through diet changes, decreasing consumption of alcohol or sugary beverages, by increasing physical activity, by losing weight, and other ways. As little as 5% to 10% reduction in body weight may lower triglycerides. The table below summarizes how much benefit different changes can effect.
Learn more about how to lower your triglycerides »
LDL and HDL: What are triglycerides?
Triglycerides are chemical compounds digested by the body to provide it with the energy for metabolism. Triglycerides are the most common form of fat in the body. They are the main ingredient in vegetable oils and animal fats.
The triglyceride molecule is a form of the chemical glycerol (tri=three molecules of fatty acid + glyceride=glycerol) that contains three fatty acids.
To be absorbed, these parts are broken apart in the small intestine, and afterwards are reassembled with cholesterol to form chylomicrons. This is the source of energy for cells in the body.
Fat cells and liver cells are used as storage sites and release chylomicrons when the body needs the energy.
Elevated triglyceride levels are a risk factor for atherosclerosis, the narrowing of arteries with the buildup of fatty plaques that may lead to heart attack, stroke, and peripheral artery disease. Markedly elevated triglyceride levels may also cause fatty liver disease and pancreatitis.
Certain diseases and conditions may cause elevated triglyceride blood levels, for example:
Alcohol consumption can raise triglyceride blood levels by causing the liver to produce more fatty acids.
However, there are some beneficial aspects of moderate alcohol consumption, defined as one alcoholic beverage per day (a glass of wine, a bottle of beer, or an ounce of hard liquor), that may balance this triglyceride rise.
Moderate alcohol consumption may mildly increase HDL (the good cholesterol) levels in the bloodstream and red wine, which contains antioxidants, may decrease the risk of heart disease. However, it is not recommended that people start to drink alcohol to obtain these effects.
Heart Health Pictures: How to Lower Triglycerides See Slideshow
How are triglyceride levels measured?
Triglyceride levels in the blood are measured by a simple blood test. Often, triglycerides are measured as part of a lipoprotein panel (lipid panel) in which triglycerides, cholesterol, HDL (high-density lipoprotein), and LDL (low-density lipoprotein) are measured at the same time.
Fasting for 8-12 hours before the test is required. Fat levels in the blood are affected by recent eating and digestion. Falsely elevated results may occur if the blood test is done just after eating.
What are normal triglyceride levels? What do elevated triglyceride levels mean?
Elevated triglycerides place an individual at risk for atherosclerosis. Triglyceride and cholesterol levels are measured in the blood to provide a method of screening for this risk.
- Normal triglyceride levels in the blood are less than 150mg per deciliter (mg/dL).
- Borderline levels are between 150-200 mg/dL.
- High levels of triglycerides (greater than 200 mg/dl) are associated with an increased risk of atherosclerosis and therefore coronary artery disease and stroke.
- Extremely high triglyceride levels (greater than 500mg/dl) may cause pancreatitis (inflammation of the pancreas).
What causes low triglyceride levels?
Returning triglyceride levels to normal may decrease the risk of heart attack, stroke, and peripheral artery disease. Controlling high triglycerides and high cholesterol is a lifelong challenge.
A healthy lifestyle includes eating well, exercising routinely, smoking cessation, and weight loss. This may be all that is needed, but some people additionally require medications to lower triglyceride levels in the blood.
Your health-care professional will help make decisions with you to decide what treatment combination is most appropriate.
What are triglycerides? See Answer
Changes in diet to lower triglycerides
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The following dietary changes may be helpful in lowering triglycerides.
- Decreasing your intake of sugar: If you have a sweet tooth, try to set limits on how often and how much sugar you consume. You can cut your intake in half to begin with, and continue cutting back from there. Remember to read the labels to check for sugar content in both food and beverages.
- Changing from white to brown: If you eat white rice, bread, and pasta, switch to whole wheat products. It may take a little while to get used to the difference in taste, but it's worth the effort for the benefits to your health. A variety of whole-wheat products are available so experiment until you find the one that you best.
- Switching fats: Limit or avoid foods with saturated and trans fats. These include fried foods, lard, butter, whole milk, ice cream, commercial baked goods, meats, and cheese. Read the nutrition labels to determine whether these unhealthy fats are present.
Switch to monounsaturated and polyunsaturated fats instead of trans or saturated fats. The best sources of these fats are olive oil, canola oil, nuts, and fatty fish salmon, mackerel, lake trout, sardines, herring, and albacore tuna. Learning to interpret food labels will help you understand the kinds of fat in the food you buy and consume.
Medically Reviewed on 9/11/2019
Jameson, JL, et al. Harrison's Principles of Internal Medicine, 20th ed. (Vol.1 & Vol.2). McGraw-Hill Education 2018.
University of Massachusetts Medical School. Triglycerides.
Cholesterol & Triglycerides: What You Need to Know
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Everywhere you turn, you are admonished to pay attention to your cholesterol levels, and to a lesser extent, your triglyceride levels. Cholesterol and triglycerides are two forms of lipid, or fat, that circulate in your bloodstream. They are both necessary for life itself.
Cholesterol is critical for building and maintaining key parts of your cells, such as your cell membranes, and for making several essential hormones — including the estrogens, progesterone, vitamin D, and steroids. Triglycerides, which are chains of high-energy fatty acids, provide much of the energy needed for your tissues to function. So you can't live without either of these types of lipids.
But when blood levels of cholesterol or triglycerides become too high, your risk of developing heart attack, stroke, and peripheral vascular disease is significantly increased. And this is why you need to be concerned about your lipid levels.
There are two sources for cholesterol and triglycerides — dietary sources and “endogenous” sources (manufactured within the body). Dietary cholesterol and triglycerides mainly come from eating meats and dairy products. These dietary lipids are absorbed through your gut and then are delivered through the bloodstream to your liver, where they are processed.
One of the main jobs of the liver is to make sure all the tissues of your body receive all the cholesterol and triglycerides they need to function.
Generally, for about eight hours after a meal, your liver takes up dietary cholesterol and triglycerides from the bloodstream. During times when dietary lipids are not available, your liver itself produces cholesterol and triglycerides.
In fact, about 75% of the cholesterol in your body is manufactured by the liver.
Your liver then places the cholesterol and triglycerides, along with special proteins, into tiny sphere-shaped packages called lipoproteins, which are released into the circulation. Cholesterol and triglycerides are removed from the lipoproteins and delivered to your body's cells, wherever they are needed.
Excess triglycerides — those that are not needed immediately for fuel — are stored in fat cells for later usage. It is important to know that many of the fatty acids stored in our bodies originated as dietary carbs.
Because there is a limit to how many carbohydrates we can store in our bodies, any “extra” carbs we eat are converted to fatty acids, which are then packaged as triglycerides and stored as fat. (This explains why it is easy to become obese even on a low-fat diet.
) The stored fatty acids are split from the triglycerides and burned as fuel during periods of fasting.
You will often hear doctors and dietitians talk about two different “types” of cholesterol — low-density lipoprotein (LDL) cholesterol (so-called “bad” cholesterol), and high-density lipoprotein (HDL) cholesterol (or “good” cholesterol). This way of talking about cholesterol is a convenient shorthand, but strictly speaking, it is not really correct.
Strictly speaking, as any good chemist will tell you, cholesterol is just cholesterol. One molecule of cholesterol is pretty much the same as another. So why do doctors talk about good and bad cholesterol?
The answer has to do with lipoproteins.
Lipoproteins. Cholesterol (and triglycerides) are lipids, and therefore do not dissolve in a water medium blood.
In order for lipids to be transported in the bloodstream without clumping together, they need to be packaged into small particles called lipoproteins.
Lipoproteins are soluble in blood, and allow cholesterol and triglycerides to be moved with ease through the bloodstream.
The “behavior” of the various lipoproteins is determined by the specific kinds of proteins (called apolipoproteins) that appear on their surface. Lipoprotein metabolism is quite complex, and scientists are still working out all the details. However, most doctors concern themselves with two major types of lipoproteins: LDL and HDL.
LDL Cholesterol — “Bad” Cholesterol. In most people, the majority of the cholesterol in the blood is packaged in LDL particles. LDL cholesterol is often called “bad” cholesterol.
Elevated levels of LDL cholesterol have been strongly associated with an increased risk of heart attack and stroke.
It is thought by many experts that when LDL cholesterol levels are too high, the LDL lipoprotein tends to stick to the lining of the blood vessels, which helps to stimulate atherosclerosis.
So, an elevated LDL cholesterol level is a major risk factor for heart disease and stroke.
While there is no question that elevated LDL cholesterol levels contribute strongly to cardiac risk, in recent years, experts have begun to question whether reducing LDL cholesterol levels itself necessarily reduces the risk.
In particular, while lowering LDL cholesterol levels with statin drugs significantly reduces cardiac risk, reducing LDL cholesterol levels with most other kinds of drugs has not been shown definitely to do so.
Current guidelines on treating cholesterol rely so strongly on the use of statins because they don't just lower cholesterol, but contribute to plaque stabilization and have possible anti-inflammatory effects.
“HDL Cholesterol — Good” Cholesterol. Higher blood levels of HDL cholesterol levels are associated with a lower risk of heart disease, and conversely, low HDL cholesterol levels are associated with an increased risk. For this reason, HDL cholesterol is commonly called “good” cholesterol.
It appears that the HDL lipoprotein “scours” the walls of blood vessels and removes excess cholesterol.
So the cholesterol present in HDL is, to a large extent, excess cholesterol that has just been removed from cells and blood vessel walls and is being transported back to the liver for recycling.
The higher the HDL cholesterol levels, presumably, the more cholesterol is being removed from where it might otherwise cause damage.
In recent years, the notion that HDL cholesterol is always “good” has come under fire, and indeed, it now appears that the truth is a bit more complicated than simply “HDL = good cholesterol.
” Drug companies working hard to devise drugs for increasing HDL levels, for instance, so far have run into a brick wall. Several drugs that successfully raise HDL levels have failed to improve cardiac outcomes.
Results these are forcing experts to revise their thinking about HDL cholesterol.
Elevated LDL cholesterol levels can be caused by several factors, including heredity conditions such as familial hypercholesterolemia. More commonly, elevated cholesterol levels are related to poor diet, obesity, sedentary lifestyle, age, smoking, and gender (pre-menopausal women have lower cholesterol levels than men).
Several medical conditions, including diabetes, hypothyroidism, liver disease, and chronic kidney failure can also increase cholesterol levels. Some drugs, especially steroids and progesterone, can do the same.
Many clinical studies have shown that having a high triglyceride blood level — a condition called hypertriglyceridemia — is also associated with a substantially elevated cardiovascular risk.
While this association is generally accepted by experts, it is not yet agreed that elevated triglyceride levels are a direct cause of atherosclerosis, as LDL cholesterol is thought to be.
There is no generally accepted “triglyceride hypothesis.”
Still, there is no question that hypertriglyceridemia is strongly associated with elevated cardiovascular risk. Furthermore, high triglyceride levels are a prominent feature of several other conditions known to increase cardiac risk. These include obesity, sedentary lifestyle, smoking, hypothyroidism — and especially metabolic syndrome and type 2 diabetes.
This latter relationship is particularly important. The insulin resistance that characterizes metabolic syndrome and type 2 diabetes produces an overall metabolic profile that tremendously increases cardiac risk.
This unfavorable metabolic profile includes, in addition to hypertriglyceridemia, elevated CRP levels, high LDL cholesterol levels, and low HDL cholesterol levels. (In fact, there is usually a “see-saw” relationship between triglyceride and HDL cholesterol levels — the higher the one, the lower the other.
) People with insulin resistance also tend to have hypertension and obesity. Their overall risk of heart disease and stroke is very high.
Given the plethora of risk factors that usually accompany high triglyceride levels, it is understandable that researchers so far have been unable to tease out just how much of the elevated risk is directly caused by the hypertriglyceridemia itself.
Beginning at age 20, testing for cholesterol and triglycerides is recommended every five years. And if your lipid levels are found to be elevated, repeat testing should be done yearly.
Deciding on whether you ought to be treated for high cholesterol or high triglyceride levels, whether that treatment ought to include drug therapy, and which drugs ought to be used is not always entirely straightforward.
Still, if your cardiovascular risk is elevated, the right treatment aimed at your lipid levels can substantially reduce your chances of having a heart attack, or even of dying prematurely. So when it comes to treating cholesterol and triglycerides, it is important to get it right.
You can read about current thinking on when and how treatment for blood lipids should be chosen.
Elevated levels of LDL cholesterol and triglycerides are strongly associated with a high risk of cardiovascular disease.
While there remains some controversy over just how much the elevated cholesterol levels and triglyceride levels themselves directly cause heart disease, there is no controversy about this: If your cardiovascular risk is elevated you need to reduce it; and further, the measures you take to lower your abnormal lipid levels will also lower your cardiac risk. So, let the experts argue about the mechanisms by which cholesterol and triglycerides are associated with heart disease. You should concentrate on taking the steps proven to lower your own, individual risk.
Why Are Your Triglycerides Low? Link to LDL & HDL Levels
While most people worry about high triglycerides, your levels are low. What does this mean? If triglycerides are harmful, can levels be too low? Read on to understand what low levels mean, what decreases them, and how they interact with HDL and LDL cholesterol values.
Low Levels Are Usually Protective
It is well known that high triglycerides are dangerous, but little is known about the influence of low levels on health. Studies suggest that in healthy people, low triglyceride levels are beneficial. Low triglycerides are also good for people with diabetes and might also be protective against heart attacks [1, 2].
One study even suggests that the lower a person’s triglycerides are, the less ly they will be to die from any cause. In this study, almost 14k people were followed for 24 years. The scientist found that levels below 89 mg/dL – that’s almost twice lower than the borderline-normal value of 150 mg/dL – were associated with a 41% lower risk of dying than high levels [3+]
So can your levels ever be too low to do any harm?
We still don’t have any definitive answers, but we can look for some clues.
Low Levels May Be Associated With Worse Outcomes in Some Conditions
In one study, people with heart failure and lower levels were more ly to die from heart complications. The levels associated with risk were around 120 mg/dL on average, while levels of 130-149 mg/dL were considered protective .
Upon further analysis, the researchers concluded that only women with heart failure and low triglycerides may be at an increased risk of dying. According to them, low triglyceride levels may point to more advanced stages of heart failure .
In another study, people with lung scarring (pulmonary fibrosis) had triglycerides under 57 mg/dL, which was about 60% lower than the values of healthy controls .
Similarly, people with autoimmune disease had 50-70% reduced triglyceride levels compared to healthy people in a different study. Researchers suggested that low triglyceride levels might actually be a marker of autoimmunity and an overactive immune response .
It’s important to note here that low triglycerides in all of these cases are not causing any of these conditions. They are the effect of these conditions. For example, in heart failure, low triglycerides may be due to liver damage (liver maker triglycerides) due to diminished oxygen supply or increased levels of inflammation.
There is no proof that low triglyceride levels are harmful in and of themselves.
What is Considered Low Triglycerides?
There isn’t an official cutoff for low triglycerides. Most labs will consider any value below 150 mg/dL normal and values below 90 mg/dL as optimal.
If you are healthy and your values are lower than normal, you probably have nothing to worry about – on the contrary.
But the studies above, in certain conditions, levels that are 50-70% lower than the average healthy person’s might signal a more serious course of disease or higher levels of inflammation [4, 5, 6].
It’s rare for people to have low triglycerides and high LDL-C, and the high LDL-C values are usually a mistake [7, 8].
A study suggests that when blood triglycerides are lower than 100 mg/dL, LDL cholesterol levels are somewhat overestimated the formula labs use. That means your triglyceride levels are correct, but your LDL-C may be lower than what the results show. The lab may need to perform a different analysis to give you a precise LDL-C value if necessary [7, 8].
This combination is usually beneficial. It has been linked with reduced risk of heart attacks 
Genetic variations can be responsible for lower blood triglyceride levels, including [9, 10, 11]:
Studies have found that genetic variations in the LPL gene (rs1801177, rs118204057, rs268, rs301, rs326, rs10096633), responsible for low blood triglycerides were associated with decreased risk of all-cause death and lower risk for heart disease [12, 13].
Mutations in the ANGPTL4 gene (E40K and T266M) and the APOC3 gene have been associated with lower blood triglyceride levels [14, 15, 16, 17, 18, 19].
In 595 healthy Taiwanese, people with the APOE genetic variant (rs429358 – TT) had significantly lower blood triglycerides .
In 80k Icelanders, a variant of the ASGR1 gene (del12 in intron 4) was associated with low blood triglycerides .
A genetic variation in the LPL gene (-93T/G) was associated with lower triglyceride blood levels in 162 African-Americans and 66 Hispanics [22, 23].
The Pima are Native Americans who live in what is now central and southern Arizona and parts of Mexico. They have enormously contributed to scientific advances through their willingness to participate in research .
The Pima were adapted to surviving in the desert, directing water, engaging in physical labor, growing vegetables, and eating a low-fat, high-carbohydrate diet. Once white settlers brought an abundance of fatty foods and a sedentary lifestyle to their communities, their prevalence of diabetes skyrocketed .
In a study from 1980, 15 obese Pima Indians had a reduced rate o VLDL-C (carriers of triglycerides) production and increased rate of triglyceride breakdown, compared to 10 obese whites .
This means that Pima Indians made fewer triglycerides and broke them down faster than the white subjects. Yet they were more obese, more prone to diabetes, and less prone to heart disease. They were adapted to a life of scarcity, one in which it was important to store energy well .
They were, however, not adapted to the modern lifestyle. These findings shaped the “thrifty gene” hypothesis: populations who have struggled with periods of limited resources and famine were more ly to survive if they were “metabolically thrifty” and stored calories efficiently. This gave them a genetic advantage, but in modern times, it puts people at risk of diabetes and obesity .
In 1,002 heart disease patients, metabolically healthier people had lower triglyceride levels after meals compared to people with an abnormal metabolic profile, regardless of their body fat .
In this study, metabolic health was evaluated using the following markers:
- Elevated blood pressure: systolic/diastolic blood pressure≥130/85 mmHg or using meds for high blood pressure
- Elevated triglyceride level: ≥150 mg/dL
- Low HDL-C level:
Should you worry about high triglycerides?
These blood fats can be one of the signs of metabolic syndrome, which increases the risk for having a heart attack or stroke.
Doctors are seeing lots of hungry patients these days, and it's not because people don't have enough to eat.
Before their appointments, patients are fasting for 9–12 hours because that's the only way to get an accurate lipid profile, the blood test that generates measurements of total cholesterol, “good” HDL cholesterol, and triglycerides. Lipid profiles have become increasingly popular because of the emphasis on lowering “bad” LDL cholesterol, and your LDL level can be calculated from a lipid profile.
Doctors have a good handle on HDL. High concentrations are better than low ones. An HDL or higher is associated with a lower risk of heart disease. Levels of 40 and below (50 for women, because their HDL levels tend to run a little higher, on average) may mean you have a higher risk, depending on you LDL level.
Until recently, triglycerides tended to get less attention when looking at cardiovascular risk. There's no question that extremely high levels (1,000 mg/dL or more) spell trouble and can lead to acute pancreatitis.
But what about treating lower levels of triglycerides? Recent evidence suggests you should work to reduce triglyceride levels of they are higher than normal, especially if you have heart disease or have other risk factors such as diabetes, high blood pressure or smoking.
|Normal||Less than 150*|
|Very high||500 or higher|
|*All values in milligrams per deciliterSource: National Cholesterol Education Program.|
A sign of metabolic syndrome
People with metabolic syndrome are several times more ly to have a heart attack or stroke. The risk of eventually developing diabetes is even greater.
A syndrome is, by definition, a group of signs and symptoms that occur together because of an underlying condition. For metabolic syndrome, that group includes abdominal obesity (as measured by waistline), high blood pressure, high blood sugar, low HDL cholesterol — and, yes, high triglyceride levels.
So as doctors have started to take metabolic syndrome more seriously, they've also started to pay more attention to triglyceride levels as one of its telltale signs.
|HDL and triglycerides are metabolically connected and are often inversely related: As triglycerides go up, HDL goes down — and vice versa. But that isn't always so. People can have “isolated” high triglycerides without low HDL levels, and research is now showing that high triglycerides are an independent risk factor for cardiovascular disease, no matter what the HDL is.|
What you can do
Many of the steps you should take to lower triglycerides are the same ones you should take to protect your heart and health overall.
If you're overweight, shed a few pounds. Get regular aerobic exercise (the kind that increases your heart rate). Limit the saturated fats in meat and dairy products. Watch your alcohol intake, even moderate drinking ramps up triglyceride levels. And diet? High-carb/low-fat eating will increase your triglycerides and lower your HDL.
If you're taking a statin to lower your LDL, one side benefit may be reduced triglyceride levels. Depending on the dose, statins can lower triglycerides by 20%–40%.
The omega-3 fats in fish and fish oil capsules are another triglyceride-lowering option. For a very high triglyceride level, your doctor can prescribe a high-dose omega-3 medication.
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What is Cholesterol?
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Is your head spinning over the conflicting messages you hear about cholesterol? That’s not surprising. Researchers are learning more about cholesterol and saturated fat. And, as they learn more, nutrition advice may change
Cholesterol is a waxy substance found in many of the foods that we eat and also in our body’s cells. Our bodies need some cholesterol to function normally and can make all the cholesterol they need. Cholesterol is used to make hormones and vitamin D. It also plays a role in digestion.
There are three main types of cholesterol in the body:
- High-density lipoprotein, or HDL. Often called the good cholesterol, HDL helps to remove excess cholesterol from your body.
- Low-density lipoprotein, or LDL. LDL is the bad or “lousy” cholesterol. It can lead to a buildup of plaque in the arteries.
- Very low-density lipoprotein, or VLDL. VLDL also tends to promote plaque buildup.
Another substance included in lipid lab tests is triglyceride levels. Triglycerides are a specific type of fat.
High triglycerides may be a sign that you have excess body fat or may be at an increased risk for Type 2 diabetes.
They also may be a signal that you are consuming too many calories, especially from refined grains or foods and beverages with added sugars. Triglycerides also can be elevated in people who smoke or drink too much alcohol.
If there is too much cholesterol in the body, it builds up. The waxy buildup, called plaque, sticks to the insides of the arteries. As the arteries narrow and clog, it is difficult for the blood to flow through them. The blockage can lead to a blood clot, stroke or heart disease.
Am I at Risk?
Many things may increase your risk for high cholesterol, including:
- Genetics: High cholesterol runs in some families.
- Age: As we age, our cholesterol levels rise.
- Medicines: Certain drugs can elevate cholesterol levels.
- Obesity: Individuals with overweight or obese body mass indices are at greater risk for high cholesterol.
- Diet: Consuming high quantities of saturated and trans fats can raise LDL cholesterol levels.
- Inactivity: Activity helps to elevate HDL cholesterol. Lack of activity has the reverse effect — it increases LDL cholesterol.
- Smoking: Tobacco products decrease HDL and increase LDL. The link between smoking and high cholesterol is greater for women.
High Cholesterol, Now What?
If your cholesterol is high because of genetics, you might need to take a cholesterol-lowering drug. However, everyone with high cholesterol can benefit from a heart-healthy lifestyle. And, if you are at risk, simple lifestyle changes can help reduce that risk. These include eating a heart-healthy diet, being physically active and achieving or maintaining a healthy body weight.
When it comes to a healthy eating plan, four dietary changes may help keep your cholesterol in check:
Enjoy Foods with Plant Sterols and Stanols
Some foods — vegetable oils, nuts, seeds and whole grains — contain substances called plant sterols and stanols. Eating foods rich in these substances may help combat rising total and LDL cholesterol levels. To increase your daily intake, also look for foods fortified with plant sterols and stanols. For example, some orange juice, cereals and breakfast bars may be fortified.
Limit Your Intake of Saturated Fat
Saturated fats are mostly found in animal-based foods such as meats and whole-fat dairy products. Higher intakes of saturated fat have been found to elevate LDL cholesterol. Studies have also shown that replacing sources of saturated fat with unsaturated fats can help decrease your total and LDL cholesterol levels. To help reduce your intake of saturated fat:
- Cook with vegetable oils, such as olive, canola, sunflower and safflower.
- Eat foods rich in omega-3 fatty acids such as salmon, walnuts and ground flaxseed.
- Choose low-fat or fat-free dairy products, such as 1% or skim milk and non-fat yogurt or low-fat cheeses, such as reduced-fat feta and part-skim mozzarella.
- Swap out butter and lard for healthier vegetable oil options.
- Avoid trans fats — they have been found to increase LDL levels and are found in highly processed foods. In the ingredients, if it says the food contains hydrogenated fat, put it back.
Select Lean Proteins
Lean proteins provide less calories from fat. To choose lean cuts:
- Check the package for the words loin or round.
- Strip the skin off your chicken and turkey to get a healthier option.
- Bake, broil, roast, stew or stir-fry lean meats, fish and poultry.
- After you cook ground meat, carefully drain off any excess fat.
- Limit fatty, marbled meats, fried or deep-fried foods and other foods that are high in saturated fat, such as organ meats
- Choose healthier options when eating out by selecting foods that are baked, broiled or grilled.
Savor Soluble Fiber
Dietary fiber is found in fruits, vegetables, beans, lentils and whole grains. These nutrient-dense foods provide two types of fiber, soluble and insoluble. Both types are important for good health. Getting adequate amounts of dietary fiber from a variety of foods is important for everyone.
Research has shown that soluble fiber, in particular, from fruits, vegetables, beans, lentils and whole grains, may help to lower LDL cholesterol. In the stomach, soluble fiber forms a thick, jelly- substance, which helps bind dietary cholesterol from foods you’re eating. So, load up on vegetables and fruits:
- Select fruits and vegetables that are good sources of soluble fiber. For example, asparagus, Brussels sprouts, sweet potatoes, turnips, apricots, mangoes and oranges.
- Eat a variety of different colored fruits and veggies.
- Shift to more plant-based or vegetarian meals by including beans, lentils and soy foods.
- Focus on whole forms of produce, which includes fresh, frozen, canned or dried fruits.
- Look for canned fruits packed in water or their own juice.
- Choose low-sodium canned veggies or varieties with no added salt.
Whole grains also are a great way to get the benefits of fiber:
- Eat barley, oats and oat bran — all are good sources of soluble fiber.
- Make sure the food label on your bread says 100 percent whole-grain or lists a whole grain as one of the first ingredients.
- Limit refined carbohydrates, especially sources of added sugars, such as sweets and sugar-sweetened beverages.
One note of caution: as you increase your fiber intake, also increase your intake of water. This will help to reduce your risk of becoming constipated. If you find it difficult to get enough fiber in your diet, ask your health care provider before considering a fiber supplement.
Relation of High TG–Low HDL Cholesterol and LDL Cholesterol to the Incidence of Ischemic Heart Disease
Abstract High triglyceride (TG) and low HDL cholesterol (HDL-C) is the characteristic dyslipidemia seen in insulin-resistant subjects. We examined the role of this dyslipidemia as a risk factor of ischemic heart disease (IHD) compared with that of high LDL cholesterol (LDL-C) in the Copenhagen Male Study.
In total 2910 white men, aged 53 to 74 years, free of cardiovascular disease at baseline, were subdivided into four groups on the basis of fasting concentrations of serum TG, HDL-C, and LDL-C. “High TG–low HDL-C” was defined as belonging to both the highest third of TG and the lowest third of HDL-C; this group encompassed one fifth of the population.
“High LDL-C” was defined as belonging to the highest fifth of LDL-C. A control group was defined as not belonging to either of these two groups. “Combined dyslipidemia” was defined as belonging to both dyslipidemic groups. Age-adjusted incidence of IHD during 8 years of follow-up was 11.4% in high TG–low HDL-C, 8.2% in high LDL-C, 6.
6% in the control group, and 17.5% in combined dyslipidemia. Compared with the control group, relative risks of IHD (95% confidence interval), adjusted for potentially confounding factors or covariates (age, body mass index, alcohol consumption, physical activity, non–insulin-dependent diabetes, hypertension, smoking, and social class), were 1.5 (1.0-2.
1), P4.5 mmol/L and did not measure LDL-C directly.
The men were subdivided into four groups on the basis of serum concentrations of fasting TG, HDL-C, and LDL-C. “High TG–low HDL-C” was defined as belonging to both the highest third of TG (cut point: 1.59 mmol/L) and the lowest third of HDL-C (cut point: 1.18 mmol/L).
This selection encompassed approximately one fifth of the study population, and accordingly we extracted a similar proportion of the population with respect to high LDL-C. Thus, “high LDL-C” was defined as belonging to the highest fifth of LDL-C (cut point: 5.25 mmol/L).
A control group was defined as not belonging to either of the two groups. “Combined dyslipidemia” was defined as belonging to both high TG–low HDL-C and high LDL-C.
Comparisons of risks and characteristics were made between those in high TG–low HDL-C (and who were without high LDL-C), high LDL-C (and who were without high TG–low HDL-C), and combined dyslipidemia, using the control group as a reference group.
In 1995, a register follow-up was carried out on morbidity and mortality between 1985/1986 and December 31, 1993. All men who had taken part in the 1985/1986 examination were traced from registers.
Information on hospital admissions and death certificate diagnoses within the follow-up period were obtained. We used the diagnoses from registers.
IHD diagnoses accepted were codes 410 through 414, International Classification of Diseases, eighth revision.
Variables of interest were expressed as mean with SD or frequency in percent. Differences between groups were tested using Student's t test or χ2 analysis.
The simultaneous contribution of several factors to the risk of IHD was analyzed using multiple logistic regression models and the maximum lihood ratio method.
In the multiple logistic regression analyses, lipids were entered either as dichotomized variables according to the dyslipidemic categories defined above, or more conventionally, lipid levels and lipid ratios were divided into equal fifths, and the results were presented as relative risk of IHD, defined as the proportionate change in risk for one-fifth change in the variable. All calculations were performed using the SPSSPC+ basic and advanced statistical software, version 3.1.1516 A value of P≤.05 was taken as significant unless otherwise stated.
The study was approved by the Ethics Committee for Medical Research in the County of Copenhagen.
Lipid characteristics of the four groups are summarized in Table 1.
By selection, TG concentrations were higher and HDL-C concentrations lower in high TG–low HDL-C and combined dyslipidemia than in high LDL-C and control groups, and LDL-C concentrations were higher in high LDL-C and combined dyslipidemia than in the other two groups.
It is seen in Table 1 that high LDL-C and combined dyslipidemia corresponded to lipoprotein phenotypes IIA and IIB, respectively.
The concentrations of total cholesterol and LDL-C were similar in the two low-cholesterol groups, high TG–low HDL-C and control group, as well as in the two high-cholesterol groups, high LDL-C and combined dyslipidemia, making it possible to examine the effects of high TG–low HDL-C independent of total cholesterol and LDL-C levels. Finally, the total cholesterol/HDL-C ratio was higher in high TG–low HDL-C than in both high LDL-C and the control group (P