From the library of
Frank Barnhill M.D.
Older doctors often told patients that cholesterol was like the “lard” part of the fat in their blood stream, and triglycerides were sort of like vegetable oil. These analogies are very much simplified and confusing. The fat content of your blood is indeed made up of cholesterol and triglycerides, but includes particles of many different sizes and consistencies. Some of these fat particles such as HDL (high density lipoproteins) protect your blood vessels, while others such as LDL-c (low density lipoproteins) cause a lot of damage and early hardening (plaque formation) of your arteries. Since we’ve discussed all of the lipoproteins in previous articles, we will just focus on elevated triglycerides in this report.
According to an intensive research program called the Adult Treatment Panel III, an eight-hour fasting triglyceride level of 150 mg/dl or less is considered normal in an adult with no current risk factors. Those obvious risk factors include: diabetes, hypertension, cigarette smoking, low HDL levels (less than 40), being over weight, age greater than 45 in men or 55 in women, and a family history of early heart disease or stroke (55 years or younger in male relatives and 65 or younger in female relatives).
The same studies determined fasting LDL-c levels (the really bad cholesterol) of more than 160 were clearly linked to a higher risk of heart attack and stroke. If you have 2 or more of the above listed risk factors, then your goal for LDL-c levels should be 130 or less. If you already are diabetic or have suffered a heart attack or stroke or have known coronary or carotid vessel disease, you should strive to achieve an LDL-c goal of 100 mg/dl or less. In the case of LDL-c levels, lower is almost always better.
How can you achieve these goals?
The single most important treatment option is to change your lifestyle. If the following dramatic changes don’t help, then medications are available to assist you in meeting your goals.
Here are suggested lifestyle changes:
Lose weight! Even a 10-pound weight loss can lower triglycerides by 5 to 10%
Exercise to burn fat calories
Stop smoking
Avoid excessive alcohol intake (fat and alcohol are both degraded in the liver)
Control blood sugar and maintain serum glucose in the normal range
Treat thyroid disease aggressively
Consider stopping or changing drugs that may increase serum glucose and triglycerides (diuretics, beta blockers, estrogens, retinoids)
If lifestyle changes fail to lower your triglycerides into the normal range, the following drugs have been shown to help:
Nicotinic Acid or Niacin can decrease triglycerides by 20 to 50% and increases HDL levels
Statins or drugs that interfere with the livers metabolism of fat, can reduce LDL-c between 18 and 55% and triglyceride levels by as much as 30%
Fibrates can decrease triglyceride levels 20 to 50% and are usually well tolerated
High dose fish oil or omega-3 fatty acids can decrease triglycerides by 20 to 30%. Unfortunately, it would require you eat many pounds of fish a week to reach the required intake levels of 6000 milligrams of omegas.
Some of these drugs will require frequent monitoring of liver functions responsible for breaking down and storing fats. If liver changes do occur, often once the offending drug is stopped, most liver tests will return to normal.
A couple of words of caution are indicated!
If you do not make the above noted lifestyle changes, it’s highly unlikely that medications will prevent progressive disease.
It’s also highly probable these recommended lipid levels will go even lower in the next couple of years as more and more data and research are available.
To a healthy heart and a long happy life!
Dr. Frank
Resources:
American Academy Of Family Physicians 2006
Safeer RS, Ugalat PS, Cholesterol Treatment Guidelines. American Family Physician 2002
Harrison’s Textbook of Medicine 2005.