Q. My cholesterol is normal, but my triglyceride level is high. Should I be concerned?

A. This is certainly worth discussing with your doctor and taking action, if necessary. Like cholesterol, triglycerides are a type of fat in the blood. Even when cholesterol levels are normal, high triglycerides increase the risk of developing heart disease, especially in postmenopausal women. High triglyceride levels are often correlated with low levels of HDL, or "good" cholesterol, and high levels of LDL, or "bad" cholesterol.

Easy ways to pump more into your diet.

Fiber is the nondigestible component of plant food that can help reduce risk for cardiovascular disease, diabetes, and obesity. But not everyone fits enough fiber into the diet. "The typical American diet includes 15 grams of fiber a day, but the daily recommendation is 25 to 35 grams per day," says registered dietitian Stacey Nelson, clinical nutrition manager at Massachusetts General Hospital.

Here's what studies have revealed about this popular beverage.

Lowering your risk of cardiovascular disease may be as easy as drinking green tea. Studies suggest this light, aromatic tea may lower LDL cholesterol and triglycerides, which may be responsible for the tea's association with reduced risk of death from heart disease and stroke.

Ask the doctor

Do I really need a statin?

Q. I am 71 years old, have chronic kidney failure, and am on dialysis.  I know my overall outlook is not good, and I wonder whether it is worth it to take a statin to control my cholesterol.

A. It's a good question. We have a tendency in medicine to prescribe statins whenever we see elevated cholesterol levels—even in people who might have conditions that make it less likely they will benefit from cholesterol reduction. That being said, the risk of cardiovascular complications is very high in people with kidney disease, and there are pretty good data that lowering cholesterol can reduce cardiac deaths and complications from atherosclerosis by about 20%. Side effect rates are so low that I think this medication is probably worthwhile for you.

High LDL cholesterol levels are known to increase the risk of heart attack, and lowering LDL levels has been proven to help protect against heart attack.

Consider this option after determining your personal risk with your doctor.

Statin drugs reduce LDL ("bad") cholesterol, the type that puts you at risk for cardiovascular disease. But even if your cholesterol is not particularly high, it could still be smart to consider starting a statin.

Statins are among the most widely prescribed drugs in the world, because they are effective at lowering low-density lipoprotein (LDL, or unhealthy) cholesterol levels. Elevated LDL levels are a major risk factor for heart disease, heart attack, and stroke. But there are many opinions about who should take statins. Some cardiologists believe statins should be prescribed to people with mild heart disease risks. Others feel statins should be reserved only for those with moderate or severe heart risks.

Controversy

Two recent studies add to the debate. One, published in The Lancet, suggested that the guidelines for statin therapy be revised to include even people at low risk for a vascular event. The other, from Harvard-affiliated Brigham and Women's Hospital (BWH), published in The Lancet, counters recent concerns that statins can be associated with an increased risk of type 2 diabetes. The BWH study found that the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard, even among those with the highest risk of developing diabetes. "The risk of developing diabetes while on statin therapy was limited almost entirely to people who had at least one major risk factor for diabetes prior to statin therapy," says Dr. Paul Ridker, the study's lead author and the director of the Center for Cardiovascular Disease Prevention at BWH. "Yet even in this high-risk group, the benefits of treatment greatly outweighed the diabetes hazard."

Discomfort usually resolves with a lower dose or a different statin.

A rare but worrisome side effect of taking a cholesterol-lowering statin is the breakdown of muscle tissue. To guard against it, people who take statins have often been advised to have regular blood tests to spot rising levels of creatine kinase (CK), a byproduct of muscle breakdown. Doctors hoped the tests would help identify the earliest stages of rhabdomyolysis, the most severe form of muscle breakdown, which can result in kidney failure and death (see box).

Concentrate on lowering LDL for now, experts advise.

HDL cholesterol is called "good" cholesterol, because higher levels of HDL are associated with lower risk of heart attack. But researchers are now questioning whether HDL protects the heart, and whether raising low levels is beneficial.

Harvard researchers studied individuals with genetically higher-than-normal HDL. In this study, published online May 12, 2012 in The Lancet, they expected a 13% lower risk of heart attack in individuals with the genetic variant. However, the risk was the same as in people who did not have the gene. "This suggests that just because an intervention raises HDL cholesterol, we cannot assume that risk for heart attack will drop," says principal study author Dr. Sekar Kathiresan, director of preventive cardiology at Harvard-affiliated Massachusetts General Hospital. "This highlights the difference between cause and association."

Cholesterol-lowering statins are a lifesaving therapy for many. But even at high doses, statins don't always produce ideally low levels of harmful LDL cholesterol.

Researchers in the TIMI Study Group at Harvard Medical School, led by Dr. Marc S. Sabatine, are testing a novel drug that may help patients reach their LDL goal safely. AMG 145 works differently than statins by binding to a protein called PCSK9, which assists in the turnover of LDL cholesterol receptors that help clear LDL from the blood. AMG 145 allows more of these receptors to circulate and remove LDL from the bloodstream. "Because AMG 145 is complementary to statins, using both should lead to greater benefit," says Dr. Sabatine.