A “lipid panel” or cholesterol panel includes four numbers: total cholesterol, LDL and HDL cholesterol, and triglycerides. The number you can most easily change in that panel is the triglycerides which bounce around depending on what you’ve eaten. Many of my patients reach out in concern after seeing high triglycerides on their results: Do I need to worry if they are high? How can I lower my triglycerides? Here are ten things you need to know.
What are triglycerides?
Triglycerides are free fatty acids in the bloodstream. Triglycerides increase with meals as fat in your diet is absorbed and travels through the bloodstream to the adipose tissue for storage. The primary role of triglycerides is to provide energy for muscles and other organs.
Fasting vs. non-fasting cholesterol panel. A hot topic.
Advice has changed, and it may not be necessary to fast (not eat for 8-10 hours) before a cholesterol test. No scientific evidence supports the use of fasting vs. nonfasting cholesterol panels when evaluating someone for cardiovascular risk. A study of 16,000 people in the U.S over 14 years found that nonfasting LDL cholesterol levels had similar predictive value compared with fasting LDL cholesterol for death from stroke and heart disease.
If triglycerides are higher after eating, shouldn’t I check them after fasting?
Not always. While fasting will lower your triglycerides an average of 26 mg/dL points, your nonfasting triglycerides better predict cardiovascular risk because fasting (obviously) may not be an accurate reflection. Studies show nonfasting triglycerides appear to be a superior predictor of cardiovascular risk than fasting levels, so in 2011, the American Heart Association published a statement stating that nonfasting triglyceride levels can screen for high triglyceride levels. The American College of Cardiology (ACC), as of 2016, recommends a fasting cholesterol panel only if used to confirm high triglycerides.
Do high triglycerides increase my risk of stroke and heart disease?
It’s unclear. Unlike the connection with LDL cholesterol, studies have failed to show that high triglycerides alone increase cardiovascular disease risk. The link of cardiovascular risk is more substantial in folks whose triglycerides are high and have a low HDL cholesterol or Type 2 Diabetes. Complicating the situation is that high triglycerides and Type 2 Diabetes often go together, and we know Type 2 Diabetes is a cardiovascular risk factor.
What causes high triglycerides?
- Diet (high saturated fat diet and alcohol)
- Genetic causes (for example, familial hypertriglyceridemia).
- Medications: Atenolol, Thiazides (hydrochlorothiazide, chlorthalidone), Tamoxifen, oral estrogens (oral contraceptives or hormone replacement therapy), steroids, and isotretinoin (accutane) are examples.
- Pregnancy, especially in the third trimester.
- Poorly controlled diabetes
- kidney disease
- Obesity and sedentary lifestyle
Do high triglycerides mean I’m at risk for diabetes?
No. But if you have three of the following: high triglycerides, increased waist circumference, elevated fasting blood sugar, high blood pressure, or low HDL cholesterol, your doctor may diagnose you with something called metabolic syndrome. Factors in the metabolic syndrome (low HDL, elevated glucose, or elevated blood pressure) predict cardiovascular disease and death, but that is not true for high triglycerides.
How high is TOO high for Triglycerides?
- If you have a nonfasting triglyceride level > 200, a confirmatory fasting cholesterol panel is reasonable within 2-4 weeks.
- A non fasting or fasting triglyceride level < 150 mg/dL is normal.
- A non-fasting or fasting triglyceride level 150-199 is borderline high, and making dietary changes to lose weight and repeating the test is recommended.
- 200 to 499 mg/dL is high, and your doctor will discuss the interventions below.
- ≥500 mg/dL is very high, and discussing treatment options with your doctor is a must.
How can I lower triglycerides?
- Weight loss. A weight loss of 5% to 10% results in a 20% decrease in triglycerides. The more weight you lose, the lower the triglycerides.
- Increased exercise. Exercise is most effective in lowering triglycerides (20% to 30%) when activity is moderate to intensive.
- Specific dietary changes like eliminating trans fatty acids (bakery shortening and margarine), avoiding added sugars, and increasing dietary fiber will help lower triglycerides.
- Omega 3 fatty acids. “Marine-Derived” Omega 3 fatty acids (EPA and DHA) provide the most benefit for lowering triglycerides. Two to four grams of EPA plus DHA per day, which comes as a prescription capsule called Lovaza, may decrease triglycerides by 25% to 30%.
What about medications to lower triglycerides?
Yet another surprise. Medications may lower your triglycerides, but there is no evidence to show they will reduce cardiovascular risk.
- Fibrates. Fenofibrate (Lofibra, Tricor) and Gemfibrozil (Lopid) are beneficial to lower triglycerides in patients with very high triglyceride levels, low HDL cholesterol, or both.
- Statins: Folks taking statin drugs to lower LDL cholesterol may also get benefit from lowering triglycerides.
- Both together? If you are taking a statin drug to lower LDL cholesterol and still have high triglycerides, there is limited evidence of any benefit to adding a second drug.
When should I have my cholesterol panel checked?
The American Heart Association recommends an initial cholesterol panel for adults 20 and older. Other organizations suggest 35 and over for men, 45 and over for women. Every 4-6 years (or more frequently) after that, which depends on your situation.
Complicated, I know, but I hope this helps.
I am a Clinical Associate Professor of Medicine at the Keck School of Medicine of USC and a board-certified Internal Medicine physician. For 20 years I’ve had an active private practice in general internal medicine currently at The Doctors of USC Beverly Hills. I am lucky to spend part of my time as the attending physician for medical students and residents during their rotations at LAC+USC Medical Center. I’ve been a medical advisor on leading health social networking sites including Dailystrength.org and Sharecare and currently serve as the medical advisor and blogger for GoodRx.com, a prescription drug price comparison website, and GoodRx care powered by Hey Doctor.
My philosophy of care centers around seeing things we can see coming, and nailing them head-on. I appreciate the idea of sharing power and responsibility for the choices one makes for prevention, treatment, and investigation into medical problems. My hope is to write blog posts to empower patients to navigate their own health by laying out the ways that medicine can guide you with strategies to investigate, prevent, and treat some common medical issues, big and small.
I have appeared on The Doctors, Fox Sports West, The Ricki Lake Show, as well as many local news outlets and have been featured in numerous online and print publications. I am a fellow of the American College of Physicians and honored to be named “Top Doctor” in Los Angeles and Pasadena Magazine for years.