Should you worry about high triglycerides?

A lipid profile is a blood test that generates measurements of total cholesterol, “good” HDL cholesterol, and triglycerides. The only way to get an accurate lipid profile is to fast 9-12 hours before the test. They 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 has been mixed. The U.S. Preventive Services Task Force says there’s insufficient evidence to recommend routine triglyceride screening. In 2001, another expert panel 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).

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. Avoid saturated fats and trans fats. 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.

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.

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.

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%.

April 2006 update

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