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 of 60 mg/dL or above may afford some protection against heart disease. Levels of 40 and below (50 for women, because their HDL levels tend to run a little higher, on average) put you at risk.

But triglycerides are a bit more problematic. Although there's no question that extremely high levels (1,000 mg/dL or more) spell trouble and can lead to acute pancreatitis, it's been less certain how hard doctors and patients should work to reduce triglycerides when they are at lower levels, but still above normal.

The message from officialdom has been mixed. The U.S. Preventive Services Task Force says there's insufficient evidence to recommend routine triglyceride screening. In 2001, an expert panel convened by the federal government's National Cholesterol Education Program released the program's third set of guidelines. On one hand, they described elevated triglycerides as simply being a marker for other risk factors. Yet the panel also said they should be given "increased weight" in cholesterol management and set cutoffs for normal, borderline, high, and very high levels (see chart).

Triglyceride levels

Normal

Less than 150*

Borderline high

150–199

High

200–499

Very high

500 or higher

*All values in milligrams per deciliter

Source: National Cholesterol Education Program.

A sign of metabolic syndrome

Metabolic syndrome goes by other names: insulin resistance syndrome, dysmetabolic syndrome, and, most ominously, syndrome X. People with metabolic syndrome are several times more likely 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.

Triglycerides go it alone

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). Avoid the saturated fats in meat and dairy products, and the trans fats in stick margarine, cookies, and many snack foods. Alcohol is a dilemma. Research shows that moderate amounts are good for your heart, but for many people, 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%.

Niacin (sometimes called nicotinic acid), one of the B vitamins, is a "threefer," reducing LDL a little, lowering triglycerides, and increasing HDL. Some people are bothered by flushing when they take niacin. Slow-release formulations may help with that problem. You can also try popping an 81-mg aspirin before you take niacin.

Fibrates, which include gemfibrozil (Lopid) and fenofibrate (Tricor), are an alternative to niacin. They reduce triglycerides by as much as 60% while raising HDL by up to 25%. The drawback: They may increase LDL levels. Sometimes people will be prescribed a statin to offset that problem, but a yellow flag should go up. The statin-fibrate combination can lead to muscle pain and weakness, which in extreme cases can be life threatening.

The omega-3 fats in fish and fish oil capsules are another triglyceride-lowering option. In studies, people taking three grams of fish oil daily have reduced their triglycerides by 30%.