|
|
|
Most first time patients in our office have a genuine concern when
asking; “Doc, what’s my cholesterol level?” While it’s true cholesterol
plays a very important role in whether you do or do not develop
cardiovascular disease at an early age, another fatty component of your
blood, serum triglycerides, can be as equally important. Elevated
triglyceride levels have clearly been shown to be an independent risk
factor for premature stroke and heart attack.
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. |
