High Triglycerides = High Heart Risks

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Amy VanStee

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If your triglyceride levels are high, your risk for heart disease is elevated as well. Because of this, a study in the Journal of the American College of Cardiology recommends that doctors test these blood fats in their patients.

“Triglycerides traditionally have been viewed as second-class citizens,” says lead author Dr. Michael Miller, at the University of Maryland Medical Center. “LDL cholesterol has always taken center stage. We know that LDL is intimately involved in bringing cholesterol to scavenger cells, which deposit them to form plaques in the arteries.

“This study shows that triglycerides in and of themselves are also lipids to blame,” notes Dr. Miller.

How the Study Worked

The original study was designed to test the effectiveness of two LDL-lowering medications called statins in lowering the recurrence of coronary disease after a heart attack.

A new study reviewed the data on the 4,162 participants in the trial, looking at the association between triglyceride levels and the incidence of heart problems and death.

“The patients who had heart attacks came back after 30 days,” says Dr. Miller. “We measured LDL levels and triglyceride levels and followed them over the next two years, evaluating for the occurrence of new events and death. If a patient had triglyceride levels below 150 [milligrams per deciliter], there was a 27% lower risk of having a new event over time.

“After multiple adjustments for such things as age, diabetes, high blood pressure, and obesity, the risk reduction was 20%,” Dr. Miller explains.

Unlike LDL cholesterol, for which there is a recommended blood level of 70 or below, there is no recommended blood triglyceride level. However, 150 milligrams per deciliter or below is “considered as desirable,” says Dr. Miller.

When the participants were divided into four groups on the basis of both LDL and triglyceride levels, those in the group with under 150 for triglycerides and under 70 for LDL did the best. They had a 28% lower risk than those in the group with the highest readings for both LDL and triglycerides.

“At the present time, we don’t have a recommendation for triglyceride lowering, so the next logical step is a study to determine whether lowering triglycerides and LDL reduces risk more than lowering LDL alone,” Dr. Miller says. Two such studies are in progress.

You Can Lower Your Levels

Previous research has already pointed toward such a connection: A study that appeared in the medical journal Neurology found a link between triglycerides and stroke risk. And research published in the Journal of the American Medical Association showed that when high triglyceride levels showed up in nonfasting cholesterol tests, there was an increased risk for a future heart attack.

Dr. Leslie Cho, of the Women’s Cardiovascular Center at the Cleveland Clinic, notes that the new report “is not a huge surprise.” She says, “The unique thing about this study is that even if you control bad LDL cholesterol to less than 70, you still need to look at triglycerides.”

The problem with triglycerides is that “they are the most unstable fats in the body,” so that at least two readings are needed to get an accurate measure of blood levels, she explains.

You can take several measures to lower your triglyceride levels, and many of them are already recommended for reduction of coronary risk. One is to eat a Mediterranean diet, rich in fish. Omega-3 fatty acids can lower triglyceride levels, as can niacin. Exercise has a beneficial effect as well, says Dr. Miller, and statins have some triglyceride-lowering effects.

“If you can effectively get both LDL cholesterol and triglycerides down, you are going to do better,” says Dr. Miller.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 4, 2017

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Medical References

  1. Fasting Compared With Nonfasting Triglycerides and Risk of Cardiovascular Events in Women. Bansal, Sandeep, et al. JAMA, 2007, vol. 298, pp. 309-316.
  2. High Triglycerides, Other Cholesterol Raise Risk Of Stroke. Ovbiagele, Bruce. Neurology, Jan. 4, 2008.
  3. Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol After Acute Coronary Syndrome in the PROVE IT-TIMI 22 Trial. Miller, Michael, et al. J Am Coll Cardiol, 2008, vol. 51, pp. 724-730.

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