Do You Know Your Triglyceride Level?

If you have talked with your doctor about your cholesterol, there’s a good chance that triglycerides came up in the same conversation. The two are typically measured together as part of a standard blood test called a lipid panel or lipid profile. But while you probably know that high cholesterol puts your heart health at risk, you may not be familiar with the dangers that triglycerides pose at higher-than-normal levels. Let’s take a look at these blood fats, including how to know if yours are too high and what you can do to reduce your triglyceride level.

Triglycerides are a type of fat. According to the American Heart Association, triglycerides are the most common type of fat that circulates in your bloodstream. Your body makes triglycerides when it breaks down fat and carbohydrates during digestion. It then uses some of those triglycerides as an energy source and stores the rest in fat tissue for later use.

Triglycerides travel through your body in bundled particles called lipoproteins, which also transport cholesterol. Specifically, triglycerides are carried by a type of lipoprotein called VLDL, or very low-density lipoprotein. VLDL transports triglycerides through your bloodstream to where they need to go. As with cholesterol, your body needs some triglycerides to function properly. Problems begin when your triglyceride level climbs too high—a condition that affects 25% to 30% of American adults, per Harvard Medical School.

“High triglycerides increase our risk of plaque buildup in our blood vessels, called atherosclerosis, which leads to heart attacks and strokes,” says Janet Wei, M.D., a cardiologist at Cedars-Sinai’s Smidt Heart Institute in Los Angeles, CA.

She points out that high triglycerides frequently occur alongside high levels of low-density lipoprotein (LDL) cholesterol—often referred to as “bad” cholesterol—and low levels of high-density lipoprotein (HDL) cholesterol, or “good” cholesterol.

“This is very common,” she says. “But it can also occur by itself in patients with genetic (familial) hypertriglyceridemia, which is less common.” According to a review in Current Atherosclerosis Reports, an estimated 5% to 10% of adults have familial hypertriglyceridemia.

High triglycerides can develop for several reasons, says Grant Reed, M.D., a cardiologist at the Cleveland Clinic in Cleveland, OH.

“High triglycerides are often seen in patients who are obese, have type 2 diabetes, are heavy alcohol users, or are on certain medications, such as diuretics, oral contraceptive pills, and others,” he says. Per the Mayo Clinic, additional drugs that can boost your triglyceride level include:

• Beta blockers

• Corticosteroids

• Hormone replacement therapy

• Immunosuppressant medications

• Some HIV medications

What you eat also plays an important role in your triglyceride level.

“A poor-quality diet, especially diets overly rich in sugars and simple carbohydrates, can increase triglycerides,” says cardiologist Ross Simpson, M.D., Ph.D., a professor of medicine at UNC School of Medicine in Chapel Hill, NC.

Per the Cleveland Clinic, other possible causes of high triglycerides include:

• High-fat diets

• Inflammatory diseases like rheumatoid arthritis and lupus

• Kidney disease

• Lack of exercise

• Liver disease

• Smoking

• Hypothyroidism (underactive thyroid)

Your doctor measures your triglyceride level by taking a blood sample. The National Heart, Lung, and Blood Institute breaks down the ranges for healthy vs. high triglycerides in adults as follows:

• Healthy: Under 150 milligrams per deciliter (mg/dl)

• Borderline high: 150 mg/dl to 199 mg/dl

• High: 200 mg/dl to 499 mg/dl

• Very high: 500 mg/dl or higher

Some health organizations use different names for the different ranges of triglycerides, and your doctor may also. For example, the Cleveland Clinic refers to triglyceride levels of 150 mg/dl to 199 mg/dl as “mildly high” rather than “borderline high.”

High triglycerides, says Dr. Reed, are linked to atherosclerosis, a process in which a sticky substance called plaque builds up on the walls of your arteries throughout your body. This causes the arteries to harden and stiffen, which in turn hampers blood flow. Atherosclerosis can lead to:

• Coronary artery disease, in which plaque accumulates in the arteries that deliver blood to your heart.

• Carotid artery disease, in which plaque accumulates in your carotid arteries, which deliver blood to your brain.

• Peripheral artery disease, in which plaque accumulates in the arteries that deliver blood to your arms and legs.

Arterial plaque can break apart, or rupture, leading to blockages that can cut off the flow of blood to your heart (causing a heart attack) or to your brain (triggering a stroke). In peripheral artery disease, severe blockages in your arteries reduce the circulation of blood to your limbs, causing pain and, in severe cases, potentially requiring amputation.

High triglycerides can also have effects beyond your cardiovascular system, Dr. Simpson notes. “Very elevated triglycerides, over 400 mg/dl, can lead to pancreatitis, a painful inflammation of the pancreas, and eventually to permanent damage to the digestive system,” he says. According to the Cleveland Clinic, a chronically inflamed pancreas can have several consequences including:

• Chronic pain

• Impaired ability to absorb nutrients from food, leading to malnutrition

• Increased risk of pancreatic cancer

• Reduced production of insulin and glucagon, hormones that regulate your blood sugar levels, potentially leading to type 1 diabetes

Though triglyceride levels often rise in concert with LDL cholesterol levels (known as mixed hyperlipidemia), Dr. Reed points out that a high triglyceride level is a red flag on its own for several conditions.

“Elevated triglycerides are often a sign of other health problems that can increase the risk of heart attack and stroke, regardless of cholesterol levels,” he says. “These include obesity, type 2 diabetes, hypothyroidism, and metabolic syndrome.”

Typically, say our experts, lifestyle changes will be the focus of treatment for high triglycerides.

“We find that unless patients can make changes in their diet and exercise, medicines are less effective,” says Dr. Simpson. Here’s what your doctor will likely recommend:

Changes to Your Diet

Dr. Simpson says it’s essential to reduce the number of calories you consume and limit alcohol and sugar.

“The most effective lifestyle changes we find for our patients are reducing sodas and sweet tea, alcohol, and then simple carbohydrates like white breads, white rice, and pasta that’s not whole grain,” he says.

Dr. Wei often recommends the Mediterranean diet, which focuses on fruits, vegetables, beans, legumes, nuts, whole grains, healthy fats like olive oil, and fish, with little to no red meat or sugar and only a moderate amount of dairy. Another healthy eating plan she likes: the Dietary Approaches to Stop Hypertension (DASH) diet, which helps to reduce blood pressure and has a similar focus on fruits, vegetables, and other nutrient-dense foods.

Dr. Simpson says your doctor or nurse can provide you with nutrition counseling, but you should consider meeting with a registered dietitian nutritionist (R.D.N. or R.D.) if possible. Your health insurance may even cover the cost.

“They are the best source of reliable, sustained guidance for diet assessments and interventions,” says Dr. Simpson.

Exercise

Dr. Wei says that getting your body moving will help to lower your triglycerides—and improve your overall health. Your goal should be at least 150 minutes of moderate intensity aerobic exercise—think brisk walking or ballroom dancing—per week. Or you could focus on vigorous exercise for at least 75 minutes per week, such as running, spinning classes, or jumping rope.

“Any physical activity is better than being inactive,” says Dr. Wei. “However, the degree of triglyceride lowering will be more successful if the activity is moderate to intensive.”

Start slowly if you’re new to exercise or if it’s been a while, and check in with your doctor before you get started, but make it your goal to gradually work up to a routine that challenges you. To get her patients started, Dr. Wei often recommends they begin by walking more.

“It can be done anywhere, and you can break it up into multiple times a day, even if it is just 5 to 10 minutes at a time,” Dr. Wei says. “Try parking further away. Then try walking up inclines or doing brisk walking or walking with weights. If you have joint pain and have access to a pool, walking in the pool is a great low-impact exercise.”

In addition to aerobic exercise, plan to incorporate muscle-building workouts into your regimen, using equipment such as weight machines and resistance bands, or doing exercises that use your body weight as resistance (such as push-ups or squats). Aim to do strength training that works each major muscle group at least twice a week, Dr. Wei advises, noting that this can further reduce triglycerides and improve heart health in general.

Medications

“If [your triglyceride] levels are very high or lifestyle interventions fail, your physician may recommend a medication to reduce triglyceride levels,” says Dr. Reed. However, he points out, it’s still unclear if triglyceride-lowering medications actually help reduce the risk of serious health problems like heart attack and stroke. He says that studies are underway now to answer that question.

The medications your doctor may prescribe include:

• Prescription grade fish oil. These contain omega-3 fatty acids, which help lower triglycerides. The prescription form, called Lovaza, typically contains a higher concentration of fish oil than over-the-counter supplements. (Speaking of OTC fish oil supplements, don’t take these without first talking to your doctor. They can interfere with certain prescription drugs and raise your risk of atrial fibrillation, an abnormal heart rhythm.)

• Fibrates. These medications, which include Atromid-S (clofibrate), Lopid (gemfibrozil), and TriCor (fenofibrate), lower triglycerides and raise your HDL cholesterol.

High triglycerides put your heart health at risk and may be a sign of serious health problems, such as diabetes. However, you can lower your triglycerides by making lifestyle changes that will improve your overall health. Medications may be necessary if diet and exercise don’t lower your triglycerides sufficiently or if your triglycerides are very high.