Possible New Treatment For High Triglycerides
In the report in The New England Journal of Medicine, an international team of researchers describe a new therapy for high triglycerides. It involves a weekly injection of “antisense oligonucleotides” , pieces of DNA that short-circuit the livers production of triglycerides. The new report shows that ASOs can reduce triglyceride levels by as much as 70%.
Keep in mind that this was a phase 2 trial, which is designed to test whether a drug does what it is supposed to do . Larger, longer-term studies will be needed to see whether ASOs actually reduce the risk of heart disease, and what sorts of side effects they cause.
Many experimental medications that sparkle in early testing never become FDA-approved drugs. We wont know for several years whether ASOs will become available for individuals with high triglycerides.
Hypertriglyceridemia What Is A Relevant Definition
The recently published Endocrine Society guidelines specifically addressed the risk for pancreatitis in subjects with very high triglyceride levels . The guidelines classified triglyceride levels in four hypertriglyceridemic categories, where the two lowest categories, together spanning triglyceride levels of 150â999 mg/dL, were considered as mild and moderate hypertriglyceridemia, respectively. The focus for this group is primarily on reducing CVD risk, while the highest category level, defined as very severe hypertriglyceridemia , is associated with risk for pancreatitis. Triglyceride levels of 1000 â 1999 mg/dL, classified as severe hypertriglyceridemia, indicate risk for development of very severe hypertriglyceridemia, causative of pancreatitis , . A recent meta-analysis, classifying increased triglyceride levels as > 500 mg/dL, confirmed an association between hypertriglyceridemia and pancreatitis . Although this new categorization attempts to provide a more clear association between triglyceride levels and pancreatitis, it adheres to the same treatment guidelines used in NCEP-ATP III. Triglyceride levels over 500 mg/dL approach and exceed the saturation level for triglyceride removal, are associated with rapid increases in post-prandial triglyceride levels, and are an indication for dietary and pharmacologic treatment.
Carbohydrate Protein And Fat
For every 1% of energy from saturated fatty acids that is replaced by 1% of energy from either carbohydrates or monounsaturated fatty acids, triglycerides increased 1.9 and 0.2 mg/dL, respectively. In contrast, when PUFAs are the replacement nutrient, triglycerides are lowered by about 0.4 mg/dL.
When 1% of energy from carbohydrates is replaced by 1% of energy from monosaturated fatty acids , triglycerides are lowered by 1.7 mg/dL when PUFAs are the replacement nutrient, triglycerides are lowered by 2.3 mg/dL. Modification to the Dietary Approaches to Stop Hypertension dietary pattern by replacing 10% of calories from carbohydrates with 10% of calories from unsaturated fat lowered triglycerides by 10 mg/dL replacing 10% of calories from carbohydrates with 10% of calories from protein lowered triglycerides by 16 mg/dL . A dose-response effect of dietary carbohydrate on triglyceride levels has been reported: triglycerides decreased by 23.9 mg/dL on a very-low-carbohydrate diet , by 15.9 mg/dL on low-carbohydrate diets , and by 8.9 mg/dL on the moderately-low-carbohydrate diets .
Table 4 Summary of Nutrition Recommendations for Patients with Hypertriglyceridemia
| TG < 500 mg/dL |
|---|
|
Meet essential fatty acid requirements |
|
For patients who need extra calories, add MCT oil gradually |
CholesterolDesserts Added sugars
MCT = medium-chain triglycerides SFA = saturated fatty acids TG = triglycerides.
One serving of fruit = 1 small piece of fruit or 1/2 cup chopped.
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Secondary Causes Of Hypertriglyceridemia
An isolated elevation in triglyceride levels may arise secondary to the use of various drugs, a high carbohydrate diet, or as a component of endocrine and other diseases, inflammation, or some rare genetic diseases. In the setting of common, underlying genetic dyslipidemias, such secondary causes can lead to severe and very severe elevations of triglyceride levels and risk of pancreatitis.
What Are The Different Triglyceride Levels
Triglycerides are a common fat in the bloodstream. They are a normal part of the blood and important for the body.
It is only when levels get abnormally high that a person may be at risk of negative health effects.
Testing reveals the triglyceride levels in the blood. As triglyceride levels increase, they fall into the following categories:
- Moderate hypertriglyceridemia: 150499 mg/dl
- Severe hypertriglyceridemia: 500 mg/dl or more
- Very severehypertriglyceridemia: 880 mg/dl or more
Desirable fasting levels of triglycerides are less than 150 mg/dl.
Triglyceride screening is typically just one part of a lipid profile blood test. The test will also check the levels of:
- total cholesterol
- low-density lipoprotein , or bad, cholesterol
- high-density lipoprotein , or good, cholesterol
Doctors may make specific recommendations ahead of the test. For example, they might ask the person to fast for
The ideal frequency of testing will depend on a persons age and other cardiovascular risk factors.
The recommend that adults undergo a cholesterol test every 46 years. The standard cholesterol test or lipid profile will measure triglyceride levels.
The test is simple and requires taking blood to test its contents.
The person may need to fast before the test. Fasting helps avoid the natural rise in triglyceride levels that happens right after a meal, giving the doctor a better idea of baseline levels.
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What Are Risk Factors For High Triglycerides
Factors that may raise triglyceride levels include:
- Excessive alcohol use.
- American Academy of Family Physicians. High Cholesterol. Accessed 11/182/2021.
- American Heart Association. Cholesterol. Accessed 11/18/2021.
- Centers for Disease Control and Prevention. Getting Your Cholesterol Checked. Accessed 11/18/2021.
- Hormone Health Network. Triglycerides. Accessed 11/18/2021.
- MedlinePlus. Triglycerides Test. Accessed 11/18/2021.
- Merck Manual Consumer Version. Overview of Cholesterol and Lipid Fats. Accessed 11/18/2021.
- National Heart, Lung and Blood Institute. High Blood Triglycerides. Accessed 11/18/2021.
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Dietary Modifications And Effects On Triglycerides
The dietary macronutrient profile has a significant impact on the expected reduction on triglycerides. Triglycerides are transported in both chylomicrons, which transport dietary fat, and very-low-density lipoprotein , which transports endogenous triglycerides formed by the liver. Both chylomicrons and VLDL are hydrolyzed by lipoprotein lipase, which is the major mechanism for clearance of triglyceride-rich lipoproteins. Clearance of triglycerides from plasma is saturable when plasma triglyceride levels exceed approximately 500 to 700 mg/dL and further input of chylomicrons and VLDL into plasma cannot readily be removed, leading to marked hypertriglyceridemia and chylomicronemia, even after an overnight fast . Dietary recommendations should be individualized based on fasting triglyceride levels as well as the risk of pancreatitis, with increasing limitation of added sugars, total fat, and alcohol intake for individuals with more severe elevations of triglycerides and chylomicrons as well as for those at high risk for pancreatitis. In a study that evaluated the effect of an individualized lifestyle intervention in patients with elevated triglycerides, there was a 48% reduction in triglyceride levels regardless of the patients lipid-lowering medications .
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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.
What Are Very High Triglycerides
Just as it sounds, having very high triglycerides means that you have too much of this type of fat in your blood. Your doctor may call this condition severe hypertriglyceridemia.
It is detected through a simple blood test called a lipid panel or lipid profile. This test measures your:
- Overall cholesterol
- HDL cholesterol
- Triglycerides
You will likely be asked to get your blood taken after fastingwhen you havent had any food or drink for eight, and sometimes up to 12 hours. This will show your triglyceride level when your body has cleared any cholesterol from meals youve eaten. A triglyceride level done without fasting can also be very revealing because it often shows that your body is not clearing the cholesterol from food.
Your health care provider will likely use your fasting results to guide treatment, but cases can be very different
Like other types of cholesterol, triglycerides are measured in milligrams per deciliter of blood. There are four categories of triglyceride levels according to the American Heart Association. Someone is diagnosed with very high triglycerides when the amount of triglycerides found in the blood is 500 mg/dL or more under 150 mg/dL is considered normal.
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High Triglycerides And Cholesterol: What Is The Difference
Your body needs a certain amount of fat to help promote its cell structure and metabolic function. The term fat is broad and refers to multiple different forms that your body creates or receives from food. Triglycerides are one form that your body produces to store excess energy from your diet. The term cholesterol is broad and used to describe a type of fat floating around in your bloodstream these include HDL and LDL. Cholesterol is produced by the body but it can also be derived from food. It is used for cell and hormone production.
When a person has high levels of LDL, or bad cholesterol, combined with high levels of triglycerides, the chances of plaque formation in their arteries increases, increasing their risk of atherosclerosis .
Not all cholesterol is bad, however, as HDL, or good cholesterol, helps to keep cholesterol from building up inside your arteries and transports it to the liver instead, where it can be expelled from the body.
You need balanced levels of both cholesterol and triglycerides to maintain good cardiovascular health.
Triglycerides And The Liver
High triglyceride levels can be a clue that you have fatty liver disease. Poor eating habits lead not only to high levels of fat in the bloodstream but increased storage of fat throughout the body, including in the liver. Elevations in liver function tests can indicate that fatty liver is present. Fatty liver usually does not cause symptoms, but unless reversed, fatty liver can lead to permanent liver damage and cirrhosis.
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What Causes Levels To Fluctuate
Triglyceride levels fluctuate naturally in response to many factors, including calorie intake and time of day. Eating a meal can cause an increase in triglycerides, which the body may store to use later when it needs energy.
These fluctuations are typically short-lived, but they are part of the reason why doctors may ask a person to fast before getting a lipid profile blood test.
Some health conditions may increase the risk of higher triglyceride levels. According to the
- hormone medications
- immunosuppressant drugs
Anyone who is uncertain about the side effects of their specific medication should speak with their doctor.
A person can use a few treatments to help lower their triglyceride levels.
Enhancing Healthcare Team Outcomes
The management of hypertriglyceridemia is by an interprofessional team that includes an endocrinologist, gastroenterologist, internist, primary care provider, nurse practitioner, and a cardiologist. Besides pharmacological therapy, the key is to educate the patient on changes in lifestyle and addressing the secondary causes.
Lifestyle changes include dietary changes such as reduction of carbohydrate intake, avoidance of sugar-sweetened beverages, and processed carbohydrates, regular exercise, and weight loss. Weight loss of 5% to 10% is associated with a reduction of triglyceride levels. Similarly, regular aerobic exercise can reduce triglycerides. The amount of decrease in triglycerides due to exercise and dietary modifications is usually variable. Many studies have shown that monounsaturated fatty acid-rich Mediterranean-type diet has reduced postprandial lipemia. When triglyceride levels are in excess of 500 mg/dL, restriction of dietary fat is key to avoid a postprandial rise in chylomicrons and thereby reduce the risk of pancreatitis.
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How Are Triglycerides Different From Cholesterol
Triglycerides and cholesterol are both fatty substances called lipids. But triglycerides are fats cholesterol is not. Cholesterol is a waxy, odorless substance made by the liver. It is used to build cell walls, helps the nervous system and plays an important role in digestion and hormone production.
Parameters To Be Tested
Besides total cholesterol, TG, HDL-cholesterol, and LDL-cholesterol, the lipid profile should include the calculated non-HDL-cholesterol concentration . In addition to elevated TG, patients with hypertriglyceridemia typically have increased total cholesterol, decreased HDL-cholesterol, and normal to low LDL-cholesterol levels. The increase in total cholesterol is explained by the fact that all triglyceride-rich lipoproteins also contain cholesterol, which then raises the total cholesterol level. The parameter non-HDL-cholesterol specifies the amount of cholesterol associated with triglyceride-rich lipoproteins . The advantage of determining non-HDL-cholesterol is that the concentration of all atherogenic lipoproteins can be estimated by measuring one single parameter. The level of non-HDL-cholesterol is more closely correlated with adverse cardiovascular events than that of TG as it also includes LDL-cholesterol. Furthermore, atherogenicity increases with rising TG levels only if more lipoproteins are present, not when existing lipoproteins are loaded with additional TG . Here, the concentration of remnant cholesterol islike the concentration of apolipoprotein Bsuperior to TG concentration as a marker for the amount of abnormal lipoproteins .
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Ask About Fish Oil Supplements
As important as exericse and diet are to heart health, treating high triglycerides usually requires an extra punch. And that’s where omega-3 fish-oil supplements often come in.
Dr. Greenfield recommends looking for fish-oil formulations that are purified and contain both key types of omega-3s, EPA and DHA , for lowering triglycerides.
After checking with your doctor, Dr. Greenfield and others recommend taking 2 to 4 grams of EPA/DHA per day to lower high triglycerides. Since dietary supplements arent regulated in the U.S., look for the USP Dietary Supplement Verification seal so that you can be more confident that youre getting what it says on the label.
Its also a good idea to take them with food, and spread out through the course of the day, to avoid side effects such as nausea and burping up a fishy taste.
Fish oil dietary supplements have an excellent track record thus far and have health maintenance benefits for the typical person who doesnt eat oily fish regularly, explains Ann C. Skulas-Ray, Ph.D., assistant professor in the department of nutritional sciences at The University of Arizona College of Agriculture and Life Sciences in Tucson, AZ.
How Are Triglycerides Measured
Your doctor may give you a common test called a lipid panel. It checks for different types of cholesterol, including the levels of the “good” kind and the “bad” kind. The American Heart Association recommends that everyone 21 and older get a lipid panel at least every 5 years.
The levels are checked after an overnight fast. Fat from a recent meal can muddy the picture.
These tests are important because you rarely have any symptoms when your triglycerides are high, unlike with many other conditions.
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When To Contact A Doctor
While high triglyceride levels may not usually cause symptoms, anyone who is uncertain or concerned about their triglyceride levels should consult a doctor.
Additionally, any adult who has not had a lipid profile test in the last 46 years should speak with a doctor about their cardiovascular risk factors and possible need for a test. Catching elevated levels of health markers, such as triglycerides or cholesterol, at an early stage may help a person make changes earlier to address the underlying issue.
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- Arnett, D. K., et al. . 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.
Causes And Symptoms Of High Triglycerides
The most common cause of high triglycerides is uncontrolled diabetes. Being overweight or obese, eating a lot of carbohydrates or sugar, consuming high amounts of alcohol, having hypothyroidism, kidney disease, certain inherited lipid disorders, and being on estrogen therapy for menopause symptom management can raise your triglyceride levels, too. High triglycerides can also be a symptom of a metabolic disorder, which increases your risk of heart disease, diabetes, and stroke.
Generally, high triglycerides dont present any symptoms, but if they are caused by a genetic disorder, you may develop fatty deposits beneath the skin.
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Dangers Of Low Triglycerides
Low triglyceride levels are generally not dangerous. In fact, research supports the idea that low triglyceride levels can offer certain health benefits.
In one 2014 study, researchers found that lower non-fasting triglyceride levels were associated with a reduction in all-cause mortality in almost 14,000 study participants.
Another smaller 2017 study found that low triglyceride levels were linked to improved brain function in older adults without dementia.
However, incredibly low triglyceride levels may be linked to other conditions, as mentioned above. Some of these conditions in and of themselves may be dangerous, so it becomes important to treat the underlying condition thats causing low triglycerides.
Why Lowering High Triglyceride Levels Matters
The national guidelines for fasting triglyceride levels in healthy adults are:
- Normal: Under 150 milligrams per deciliter .
- Borderline High: 151200 mg/dl.
- High: 201499 mg/dl.
- Very High: 500 mg/dl or higher.
When your triglyceride levels are high and you have a high amount of LDL cholesterol or a low amount of HDL cholesterol, all of this could contribute to the development of fatty buildups within the artery walls of the heart. The buildup can increase your risk of heart attack and stroke.
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