Best Statin For High Triglycerides

Hypertriglyceridemia Management According To The 2018 Aha/acc Guideline

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The 2018 AHA/ACC Guideline on the Management of Blood Cholesterol was a welcome update from the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.1 Our new guideline reinforces the importance of a heart-healthy lifestyle, the use of statins as the first line agent in primary and secondary cardiovascular prevention and the importance of risk stratification to identify those who benefit most from these measures. Also of note, our new guideline features a specific section on hypertriglyceridemia. This section is composed of one class I and three class IIa recommendations followed by a synopsis and supportive text to assist clinicians in recognising and treating patients with hypertriglyceridemia.

Identify and Address Secondary Factors

The class I recommendation first identifies a population 20 years of age or older who have moderate hypertriglyceridemia defined as fasting or nonfasting triglycerides 175-499 mg/dL and advises searching for and treating secondary factors . The remaining three recommendations build on this.

Table 1: Secondary Factors

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Use of Statin Therapy in Moderate Hypertriglyceridemia

Use of Statin Therapy in Severe Hypertriglyceridemia

The third recommendation endorses the initiation of statins in those with severe hypertriglyceridemia with ASCVD equal to or greater than 7.5% in concert with addressing secondary factors.

Other Therapies in Severe Hypertriglyceridemia

Truths About Statins And High Cholesterol

For every drop of scientific evidence that statins are safe and effective, there is a tidal wave of misinformation. Our patients are concerned about statin side effects theyve heard about from family or friends, or read about on the Internet.

Statins are the gold-standard for high cholesterol treatment. Theyre a powerful medication, and theyve been proven to save the lives of many men and women living with or having a high risk of heart attack or stroke.

But if statins are so effective, why are some people afraid to take them?

As with any medication, there are risks associated with taking statins, but the benefits far outweigh the risks for the vast majority of high-risk patients.

In an effort to put statin side effects into context and provide honest, scientific answers about statins and their use, weve put together a list of common questions our patients ask us:

Lifestyle Therapy: The First Step

With so many people in need and so many medications available, it’s understandable that both doctors and their patients are tempted to rely on medications to improve unhealthy cholesterol levels. That’s a mistake. Instead, lifestyle therapy is the place to start. That means avoiding tobacco in all its forms. It also means choosing foods low in saturated fat, trans-fatty acids, and cholesterol while favoring foods that provide heart-healthy omega-3 and monounsaturated fats and large amounts of dietary fiber. It also requires regular exercise, which can be as simple as walking at a moderate pace for at least 30 minutes nearly every day. And the combination of a good diet and regular exercise should help men achieve another important goal, weight control.

Lifestyle therapy can improve cholesterol levels, and certain foods can provide extra help . But even with clean living, many people need medication to achieve optimal cholesterol levels, particularly when they have to reduce their LDL levels to 100 mg/dL or less. It’s important to keep up a good diet and exercise program even if you take medication. And if you can’t take a statin, here is a rundown of other medications that can help Table 3 summarizes their effects on blood lipids and compares them to the statins.

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Why Do Doctors Focus On My Ldl Cholesterol

Some cholesterol is necessary for normal cell and body function. But too much cholesterol can lead to atherosclerosis , which results in heart disease, heart attack, and stroke.

There are two types of cholesterol: high-density lipoprotein and low-density lipoprotein . The amount of each that circulates in your blood is added together to form your total cholesterol number. Thus, focus on total cholesterol can be confusing as it may be elevated due to high HDL cholesterol.

When your LDL cholesterol is above 130 it is considered borderline, while above 160 is considered high. Ideally, we would all have an LDL under 100 , but not everyone needs medications above this level.

We focus on the bad cholesterol because it is one of the main culprits responsible for blocking and hardening the arteries. A blocked artery can lead to a heart attack or stroke. Statin therapy helps control the bad cholesterol of patients who are at high risk for heart disease, stroke, and other serious cardiovascular events. In general, the lower your LDL levels, the better off you will be.

Theres a lot of science around how HDL cholesterol affects your risk for heart disease. But its the function how well it works that may be more important thanhow high its level is.

Lifestyle Intervention Clinical Workflow

A summary of nutrition recommendations for patients with hypertriglyceridemia appears in Table 4.

Sample questions to assess each lifestyle behavior that affects triglyceride levels are presented in Table 5. This information can be collected relatively quickly during an office visit, provides key information about the lifestyle behavior to modify, and is collected in a manner that can build a bond of human caring between the patient and the clinician .

Table 5 Screening Questions for Assessing Effects of Lifestyle on Triglycerides

How often do you consume sugar-sweetened beverages ?

Do you consume sweets ? If so, how much and how often?

Do you drink alcoholic beverages ? If so, how much and how often?

How often do you consume foods that are deep fried or high in saturated fats as well as pizza?

Have you gained weight in the past year? If so, how much weight have you gained?

What do you do for physical activity? How often?

Some example follow-up messages to encourage lifestyle behavior change in patients appear in Table 6. Interventions should last a minimum of 4 to 12 weeks to assess their efficacy.

Table 6 Clinician Messages to Patients to Encourage Healthy Lifestyle Behaviors

Please refer to Section 6.2 and Figures 2 and 6 for more detailed recommendations for management of patients with severe hypertriglyceridemia, as defined as 500 mg/dL and especially 1,000 mg/dL.

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What Causes High Triglycerides

Aside from consuming a high-fat and/or high-carb diet, other lifestyle factors can contribute to high triglycerides, specifically excess weight, lack of exercise, drinking too much alcohol and smoking. Dr. Malaney adds that it can also be a side effect of certain medications, such as some birth control pills, beta blockers, antipsychotics medications, and corticosteroids.

What Qualifies As High Triglycerides

According to MedlinePlus , blood levels less than 150 mg/dL fall under the triglycerides normal range, while anything higherknown as hypertriglyceridemiacan increase risk for heart disease. Elevated triglycerides can also be a very early sign of diabetes, states Kristin Thomas, MD, a board-certified internist and co-founder of Foxhall Medicine in Washington, DC.

Extremely high triglyceridesblood levels over 500 mg/dLmay be due to a genetic disorder and can increase the risk of pancreatitis, along with heart disease, including atherosclerosis , Dr. Thomas, co-author of You Can Prevent A Stroke, explains. It can be seen alone or in association with many other conditions, as well, such as metabolic syndrome, hypothyroidism, fatty liver disease and kidney disease, Dr. Malaney says.

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Do Statins Cause Muscle Pain And Weakness

Muscle aches occur in about 10 percent of people who take statins. Its the most common side effect of statins, but another way to look at it is that nine out of 10 patients dont experience it at all.

When patients do have muscle pain:Actual muscle damage occurs in only 1 in 10,000 patients. In the rare event that muscle damage occurs, it is almost always reversible. To correct it while still protecting you from heart attack or stroke, we can adjust your medication or try a different statin. There also are many strategies to effectively manage muscle symptoms while continuing to take your medication.

If you experience muscle pain while taking a statin, dont stop taking it without first talking with your doctor. For almost all patients, were able to find an effective medication that the body can tolerate. If you simply cant tolerate statins, there are other cholesterol medications we can prescribe.

• The symptom is often resolved by adjusting the medication dosage or switching to a different statin.
• Occasionally, the statins have to be stopped altogether.
• When the medication is switched or stopped, the symptoms go away and there is no damage to the muscle.

How Pcsk9 Inhibitors Work

PCSK9 inhibitors work to lower cholesterol in patients whove been diagnosed with coronary artery disease, have a genetic propensity for high cholesterol or are at high risk for heart attack or stroke. PCSK9 inhibitors may also be effective alone for certain patients who cant tolerate a statin or cant achieve goal cholesterol levels while on other cholesterol-lowering medications.

This new class of drugs successfully lowers LDL by 50 to 70% when taken alone or in combination with a statin, says Brook, citing a study in the New England Journal of Medicine that shows PCSK9 inhibitors can actually prevent heart attacks and strokes. This benefit was shown even in patients taking statins who had LDL levels below 100 mg/dL who were previously thought to be well controlled, says Brook.

These PCSK9 inhibitors target PCSK9 proteins in the liver that destroy the livers receptors responsible for removing excess cholesterol from the blood. Because these proteins are destroyed, more receptors are then able to do their job, successfully lowering the amount of LDL cholesterol in the blood.

The PCSK9 inhibitor is injected in the skin of the abdomen or upper thigh every two to four weeks. Despite promising results, a major drawback for many patients is the cost.

Read Also: What Is The Best Triglyceride Level

How Often Should I Have My Cholesterol Tested

Adults should have their blood lipids measured every 5 years, starting at 45 years. Aboriginal and Torres Strait Islander people should start lipid blood tests at 35, because on average heart and blood vessel disease such as heart attacks and stroke happen 10 to 20 years earlier in Indigenous people.

All Australians in these age groups are eligible for a regular 20-minute heart health check with their doctor. This checks your blood pressure, cholesterol and blood sugar levels. Your doctor can then assess your risk of having a heart attack or stroke in the next 5 years.

Becoming More Physically Active

A sedentary lifestyle lowers HDL cholesterol. Less HDL means theres less good cholesterol to remove bad cholesterol from your arteries.

Physical activity is important. At least 150 minutes of moderate-intensity aerobic exercise a week is enough to lower both cholesterol and high blood pressure. And you have lots of options: brisk walking, swimming, bicycling or even yard work can fit the bill.

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Lowering Triglycerides Without Medication

Unless your triglycerides are extremely high, lifestyle changes are the best place to start. These simple steps can significantly lower triglyceride levels.

• Beware of bad fats. Cutting back on saturated fat and trans fats can lower triglycerides.
• Go for good carbs. Easily digested carbohydrates give triglycerides a definite boost. Eating whole grains and cutting back on soda can help control triglycerides.
• Check your alcohol use. In some people, alcohol dramatically boosts triglycerides. The only way to know if this is true for you is to avoid alcohol for a few weeks and have your triglycerides tested again.
• Go fish. Omega-3 fats in salmon, tuna, sardines, and other fatty fish can lower triglycerides. Having fish twice a week is fine.
• Aim for a healthy weight. If you are overweight, losing just 5% to 10% of your weight can help drive down triglycerides.
• Get moving. Exercise lowers triglycerides and boosts heart-healthy HDL cholesterol.
• Stop smoking. It isnt good for triglyceride levels or for anything else.

About the Author

Gregory Curfman, MD, Assistant Professor of Medicine, Former Editor-in-Chief, Harvard Health Publishing

How To Reduce Cholesterol Through Your Diet

The USDA developed a guide for adults and children called MyPlate which replaces the obsolete food pyramid. With the MyPlate approach, there are five food groups in set proportions: fruits, vegetables, proteins, grains, and dairy.

The plate is divided into sections:

• Vegetables: 40% of the plate
• Protein: 20% of the plate
• Grains: 30% of the plate
• Fruit: 10% of the plate
• Dairy: Small cup of yogurt or a glass of fat-free milk

Dividing the plate this way makes it easier to understand the types and quantity of food to include in each meal to make it balanced. This diet plan can also help those with high cholesterol levels to eat a healthy diet without excess fat.

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Omega-3 extraction purity> 50%

Choose TG dosage form is better

Organic solvent-free production process

Capsules should be small, algae oil should be plant-based capsules

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Only the original authorized trademark is required for the outer packaging

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How To Lower Triglycerides

Your doctor will determine if you need treatment to lowering triglycerides by talking with you about your current diet and lifestyle, and evaluating your triglyceride level, your LDL cholesterol level, and your potential risk factors for coronary heart disease.

Here are some of the reasons your doctor might discuss medications to lower triglycerides with you:

• You have metabolic syndrome. This condition includes a combination of abdominal obesity, high triglycerides, and high blood pressure. If you have metabolic syndrome and tried diet and lifestyle changes for three months without success, triglyceride-lowering medications may be needed.
• Previous medication lowered your total cholesterol but not your triglycerides. If your cholesterol is well controlled, but your triglyceride level is still too high, at or above 200 mg/dL, triglyceride-lowering medications may help.
• You have very high triglycerides. If your triglyceride level is at or higher than 500 mg/dL, you may need to start medications to lower triglycerides even before reaching lower cholesterol levels.

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Can Exercise And Diet Lower Your Cholesterol Enough

Thereâs no doubt that a healthy lifestyle helps lower cholesterol. The question is whether it can lower your levels enough â and that depends on how high your levels are and what your doctor has set as your goal.

• Eating a heart-healthy diet can lower LDL cholesterol at least 10%.
• If you lose 5% to 10% of your body weight, you can cut LDL cholesterol 15%, and reduce triglycerides 20%.
• If you exercise at a moderate intensity — meaning you have enough breath to talk but not sing — for at least 2 ½ hours a week, you can further cut triglycerides 20% to 30%.

Thatâs a great start, says Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center. “Lifestyle changes certainly are the cornerstone of cholesterol reduction.”

To get your cholesterol down to lower your risk of cardiovascular disease your doctor may recommend, though, that you still need a statin. These powerful cholesterol-lowering medicines include atorvastatin , pravastatin , and simvastatin , among others.

Who Needs To Take Statins

Your healthcare provider will look at your individual situation when deciding if you should take a statin. Having diabetes, high blood pressure or high cholesterol and using tobacco products are all risk factors for getting heart disease. Your provider will also consider your age, sex and race when deciding if you need a statin.

Providers prescribe statins for people who:

• Have high cholesterol that exercise and diet changes couldnt reduce.
• Had a stroke, heart attack or peripheral artery disease.
• Have diabetes and an LDL of at least 70 mg/dL and are 40 to 75 years old.
• Have an LDL of at least 70 mg/dL and a high risk of getting heart disease and are 40 to 75 years old.

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When And Why Triglyceride Levels Should Be Treated

Triglyceride levels are only part of the picture of cardiovascular disease risk, and whats normal can depend on your individual health factors. That said, according to the U.S. National Library of Medicine, triglyceride guidelines are defined as:

• Normal: Less than 150 mg/dL
• Borderline high: 150 mg/dL to 199 mg/dL
• High: 200 to 499 mg/dL
• Very high: 500 mg/dL and above

If you are in a category above normal, your doctor will likely recommend lifestyle changes and possibly discuss medications to normalize your levels and reduce your risk of cardiovascular disease. High triglycerides seem to create some increased levels of cardiovascular risk similar to LDL cholesterol, says Andrew Freeman, MD, a cardiologist at National Jewish Health in Denver. Triglycerides can play a role in the development of atherosclerosis, or the buildup of plaque in arteries that restricts blood flow and is associated with coronary heart disease, angina, and peripheral artery disease, says the AHA.

According to Mayo Clinic, high triglycerides can often be a sign of other conditions that raise your cardiovascular disease risk, such as obesity and metabolic syndrome, which is defined as having at least three out of a group of conditions: excess abdominal fat, high blood pressure, elevated blood sugar, reduced HDL cholesterol, and, of course, high triglycerides. Extremely high triglycerides can lead to pancreatitis, or inflammation of the pancreas.