You may want to first read Triglycerides, Part 1.
Before considering treating high blood triglycerides, it makes sense to ask whether lowering triglyceride levels provides any benefits. People with triglyceride levels greater than 500 mg/dL are at risk for extremely painful and dangerous attacks of acute pancreatitis. Lowering triglyceride levels can usually prevent such attacks.
Two major studies have demonstrated that lowering triglycerides can reduce the incidence of coronary events. People with triglycerides between 200 and 500 mg/dL, who were at increased risk for heart attacks, were enrolled in the Helsinki Heart Study and the VA HIT study. They were placed on either a placebo (a pill with no medicine in it) or the triglyceride-lowering drug gemfibrozil (Lopid) over a 5-year period. In both studies the subjects treated with gemfibrozil had significantly fewer heart attacks and other cardiovascular complications than those taking a placebo. Researchers found that the cardiovascular benefits were due to small increases in the levels of protective high-density lipoprotein (HDL) cholesterol rather than the larger reductions in triglyceride levels. People with diabetes or significant resistance to insulin benefited more than other subjects.
Triglycerides can be lowered by weight loss or by drugs when necessary. Weight loss always lowers triglycerides, and one of the few promises I have made to my patients is that their triglycerides will fall if they lose weight. Some patients protest that they are not overweight, but I tell them that any weight gained after about age 20 isn?t muscle and it isn?t brains -- it?s fat. And that extra body fat is what leads to high blood levels of triglycerides.
If a patient can?t lose weight or can?t otherwise lower triglycerides enough, the present guidelines recommend that it?s time to start a medication. In fact, people with triglycerides higher than 500 mg/dL are placed on a triglyceride-lowering drug, gemfibrozil or fenofibrate (Tricor), at the same time they are urged to lose weight. They must also restrict all types of dietary fat to about 20 percent of their total calories rather than the 30 to 35 percent of calories recommended to prevent coronary heart disease.
People with triglycerides between 200 and 500 mg/dL are treated with a statin to reduce their low-density lipoprotein (LDL) cholesterol because of its clear association with coronary risk. Statins can lower triglycerides by 10 to 25 percent, but if triglycerides remain above 200 mg/dL, one of the triglyceride-lowering drugs may be added. If HDL cholesterol levels are very low, niacin may be prescribed instead.
And that?s the nuts and bolts of this often neglected compound in our blood.
