Recently, my father-in-law was told by his orthopedic surgeon that the cause of his recurrent lower back pain was not his back but his front. By this he meant that his excess abdominal weight was placing a huge stress on his already fragile lower back. He rightly prescribed exercise on a stationary bike with the instructions to “go nuts.” In the four months since he started a routine exercise regiment of stationary biking, he has lost more than 18 pounds, and he has not needed to take pain medications for that same time period.
What's more, his long battle with hypertriglyceridemia (elevated triglycerides) has also improved. His serum triglycerides have gone from 236 to 146 with exercise alone!
Why do physicians make such a great deal of this seemingly less important cholesterol marker and how do triglycerides affect our health?
Triglycerides are a type of fat, or lipid, that are present in our food and in our blood. The triglycerides in our body are either from the high fat food we eat, or are produced by our own body from high carbohydrate (sugar) food. High carbohydrate foods cause a massive surge in blood glucose levels that result in an excess of sugar that must be stored. This spill over sugar is quickly converted into triglycerides and stored by the body in fat cells. These fat cells are usually deposited on the abdomen in men and on the hips and thighs in women.
As one of the main types of fats, triglycerides are a key risk factor for several diseases. Hypertriglyceridemia is associated with increased risks for coronary artery disease, stroke, peripheral vascular diseases and rarely pancreatitis.
How severe is the problem?
In the last 40 years, the death rate of heart disease has dropped steadily with advances in prevention and therapy. However, in 2008, heart disease remains the No. 1 killer of both men and women. It claims more lives than cancer and infection, and the risk of cardiovascular disease becomes more severe as the population ages.
In a large study of the relationship between elevated triglycerides and the rate of heart disease, the risk of a heart attack was highest in men with the highest levels of triglycerides. What's worse, another study showed that there was a graded worsening of the risk of heart disease with each successive elevation in triglyceride level. Interestingly, elevated triglyceride levels are particularly associated with increased long-term heart disease in two populations, the young and women. Hypertriglyceridemia seems to be most predictive of future coronary artery disease in both young patients and female patients. In light of this, the American Heart Association and the American College of Cardiology consider elevated triglycerides to be an independent risk factor for the development of heart disease.
The mechanism between elevated triglycerides and the development of heart disease is complex. One way is that the triglycerides in our body interact with other types of cholesterol, directly forming artery-clogging plaques, called atherosclerosis. Additionally, elevated triglycerides increase the stickiness of blood and actually promote the body's own clotting mechanism, both increasing the risk of life threatening blood clot formation.
The cause of elevated triglycerides is varied. Sometimes markedly elevated triglycerides are due to a genetic disorder in which the body actually overproduces triglycerides or has a defect in the removal of triglycerides from circulation. Classically, these patients have severely elevated triglyceride levels and have a family history of accelerated vascular disease, including coronary artery disease, peripherally artery disease and stroke. In the general population, hypertriglyceridemia is due to dietary and alcohol excesses, obesity, diabetes, thyroid and kidney disease, some medications and physical inactivity.
As elevated triglycerides are an important health concern, monitoring their levels is critical. Blood levels of triglycerides are commonly measured along with cholesterol markers like LDL and HDL, and must be checked after an overnight fast. Current guidelines define triglyceride levels as: normal = less than 150 mg/dL; borderline = 150 to 199 mg/dL; high = 200 to 499 mg/dL; and very high = greater than 500 mg/dL. Markedly elevated levels of triglycerides should prompt the physician to investigate other subtypes of triglycerides and cholesterol that can help diagnose the specific cause of the hypertriglyceridemia.
The current strategy to manage hypertriglyceridemia is based on several well-established guidelines. The main therapy for hypertriglyceridemia is lifestyle modification. As always, stopping smoking and blood pressure control is key. Most important is to lose the excess weight and attain your ideal body weight. One key step is to reduce overall calorie intake from all food and drink sources. Once more, alcohol even in relatively small quantities can markedly elevate serum triglyceride levels.
Diets that are high in fruit, vegetables, and low-fat or non-fat dairy products will also make a significant reduction in triglyceride levels. Fats, especially saturated fats should be switched to mono or polyunsaturated fats like those in olive oil and canola oil. Also, try to avoid high saturated fat red meats, substituting for fresh fish high in omega-3 fatty acids, like those found in salmon, mackerel and tuna.
Both the American and European Cardiovascular Societies recommend starting therapy at triglyceride levels greater than 200 mg/dL. After lifestyle therapy has been implemented, drug therapy is often indicated. Several medications are commonly used, including the anti-cholesterol statin medications, the fibrates and nicotinic acids. Of note, the fibrates may actually elevate many statin medication concentrations to dangerously high levels, therefore caution should be employed when taking both a fibrate and a statin medication. The most effective medications for elevated triglycerides appear to be the fibrates and nicotinic acid.
For relatively difficult to control elevated triglycerides, fish oil supplements can also be helpful. High doses of good quality fish oil, up to greater than 3 grams a day, can actually reduce triglycerides in half.
Lastly, there are drugs that seem to block the bodies uptake of triglycerides from ingested food, therefore reducing absorbed fat from dietary intake.
The good news is that effective control of elevated triglyceride levels has immediate and long-term benefit. For those plagued by hypertriglyceridemia, diet, exercise and occasionally medications can get your lipid levels to target. Like my father-in-law has proven, dramatic success can be attained with adopting a heart healthy lifestyle.
Dr. David M. Donaldson is an Auburn native and currently a
cardiologist at Massachusetts
General Hospital in Boston
Why do physicians make such a great deal of this seemingly less important cholesterol marker and how do triglycerides affect our health?
Triglycerides are a type of fat, or lipid, that are present in our food and in our blood. The triglycerides in our body are either from the high fat food we eat, or are produced by our own body from high carbohydrate (sugar) food. High carbohydrate foods cause a massive surge in blood glucose levels that result in an excess of sugar that must be stored. This spill over sugar is quickly converted into triglycerides and stored by the body in fat cells. These fat cells are usually deposited on the abdomen in men and on the hips and thighs in women.
As one of the main types of fats, triglycerides are a key risk factor for several diseases. Hypertriglyceridemia is associated with increased risks for coronary artery disease, stroke, peripheral vascular diseases and rarely pancreatitis.
How severe is the problem?
In the last 40 years, the death rate of heart disease has dropped steadily with advances in prevention and therapy. However, in 2008, heart disease remains the No. 1 killer of both men and women. It claims more lives than cancer and infection, and the risk of cardiovascular disease becomes more severe as the population ages.
In a large study of the relationship between elevated triglycerides and the rate of heart disease, the risk of a heart attack was highest in men with the highest levels of triglycerides. What's worse, another study showed that there was a graded worsening of the risk of heart disease with each successive elevation in triglyceride level. Interestingly, elevated triglyceride levels are particularly associated with increased long-term heart disease in two populations, the young and women. Hypertriglyceridemia seems to be most predictive of future coronary artery disease in both young patients and female patients. In light of this, the American Heart Association and the American College of Cardiology consider elevated triglycerides to be an independent risk factor for the development of heart disease.
The mechanism between elevated triglycerides and the development of heart disease is complex. One way is that the triglycerides in our body interact with other types of cholesterol, directly forming artery-clogging plaques, called atherosclerosis. Additionally, elevated triglycerides increase the stickiness of blood and actually promote the body's own clotting mechanism, both increasing the risk of life threatening blood clot formation.
The cause of elevated triglycerides is varied. Sometimes markedly elevated triglycerides are due to a genetic disorder in which the body actually overproduces triglycerides or has a defect in the removal of triglycerides from circulation. Classically, these patients have severely elevated triglyceride levels and have a family history of accelerated vascular disease, including coronary artery disease, peripherally artery disease and stroke. In the general population, hypertriglyceridemia is due to dietary and alcohol excesses, obesity, diabetes, thyroid and kidney disease, some medications and physical inactivity.
As elevated triglycerides are an important health concern, monitoring their levels is critical. Blood levels of triglycerides are commonly measured along with cholesterol markers like LDL and HDL, and must be checked after an overnight fast. Current guidelines define triglyceride levels as: normal = less than 150 mg/dL; borderline = 150 to 199 mg/dL; high = 200 to 499 mg/dL; and very high = greater than 500 mg/dL. Markedly elevated levels of triglycerides should prompt the physician to investigate other subtypes of triglycerides and cholesterol that can help diagnose the specific cause of the hypertriglyceridemia.
The current strategy to manage hypertriglyceridemia is based on several well-established guidelines. The main therapy for hypertriglyceridemia is lifestyle modification. As always, stopping smoking and blood pressure control is key. Most important is to lose the excess weight and attain your ideal body weight. One key step is to reduce overall calorie intake from all food and drink sources. Once more, alcohol even in relatively small quantities can markedly elevate serum triglyceride levels.
Diets that are high in fruit, vegetables, and low-fat or non-fat dairy products will also make a significant reduction in triglyceride levels. Fats, especially saturated fats should be switched to mono or polyunsaturated fats like those in olive oil and canola oil. Also, try to avoid high saturated fat red meats, substituting for fresh fish high in omega-3 fatty acids, like those found in salmon, mackerel and tuna.
Both the American and European Cardiovascular Societies recommend starting therapy at triglyceride levels greater than 200 mg/dL. After lifestyle therapy has been implemented, drug therapy is often indicated. Several medications are commonly used, including the anti-cholesterol statin medications, the fibrates and nicotinic acids. Of note, the fibrates may actually elevate many statin medication concentrations to dangerously high levels, therefore caution should be employed when taking both a fibrate and a statin medication. The most effective medications for elevated triglycerides appear to be the fibrates and nicotinic acid.
For relatively difficult to control elevated triglycerides, fish oil supplements can also be helpful. High doses of good quality fish oil, up to greater than 3 grams a day, can actually reduce triglycerides in half.
Lastly, there are drugs that seem to block the bodies uptake of triglycerides from ingested food, therefore reducing absorbed fat from dietary intake.
The good news is that effective control of elevated triglyceride levels has immediate and long-term benefit. For those plagued by hypertriglyceridemia, diet, exercise and occasionally medications can get your lipid levels to target. Like my father-in-law has proven, dramatic success can be attained with adopting a heart healthy lifestyle.
Dr. David M. Donaldson is an Auburn native and currently a
cardiologist at Massachusetts
General Hospital in Boston
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