High Cholesterol | Familial Hypercholesterolemia

Very High Triglycerides

It’s a good idea to keep track of your cholesterol. The same is true for your blood pressure, blood sugar levels and waistline. And while you may be used to hearing about “good” (HDL) and “bad” (LDL) cholesterol, triglycerides are an important part of the overall picture too. Triglycerides are one of the four numbers you will see on a standard cholesterol blood (panel) test. When triglycerides are very high, it can spell trouble for your heart and lead to other health issues too. 

What are triglycerides? 

Triglycerides are a type of fat (lipid) found in your blood. 

Your liver makes triglycerides. You also get them through many of the foods you eat. In fact, after you eat, any extra calories that your body doesn’t need right away are converted into triglycerides. These fatty substances are stored in fat cells. They are later released and circulate the bloodstream to be used as energy by cells. But as with LDL cholesterol, too much can be harmful. Most dietary fats are triglycerides. 

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
  • - LDL cholesterol
  • - HDL cholesterol
  • - Triglycerides 

You will likely be asked to get your blood taken after fasting—when you haven’t had any food or drink (except water) for eight, and sometimes up to 12 hours. That’s because recent food intake can change your triglyceride level. Triglycerides are usually lowest after fasting and highest after eating. Eating a heavy meal can actually cause a spike in the amount of triglycerides in the blood. 

Like other types of cholesterol, triglycerides are measured in milligrams per deciliter (mg/dL) 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.

Classification

 Triglyceride Level (mg/dL)

 Healthy

 Below 150

 Borderline High

 150-199

 High

 200-499

 Very High

 500 and Above

What causes VHTG? 

A number of factors can raise triglycerides, or cause very high triglycerides. For example, it tends to be more common in people with:

  • Low thyroid levels (hypothyroid)
  • Poorly controlled diabetes
  • Kidney disease
  • A genetic predisposition where the body produces an excess amount of triglycerides 


Other things that can raise triglyceride levels include:

  • Certain medicines, including some birth control pills, beta blockers, antipsychotics and corticosteroids
  • A diet that is high in carbohydrates, processed or sugary foods
  • Alcohol
  • Not exercising


Are certain people more likely to develop it?

Yes. As mentioned, some people have a genetic deficiency or family history that makes them more prone to very high triglycerides. The condition is also more common in:

  • People who are very overweight/obese
  • Women, especially those who are pregnant, are taking estrogen or hormone replacement therapy, or have polycystic ovary syndrome
  • People who develop heart disease before age 50
  • Mexican-American men
  • Indian Americans


Are there signs and symptoms?

Not usually, though people with very high triglycerides may have coronary disease at an early age. Because there aren’t any overt symptoms, it’s a good idea to ask about routine blood testing to check your blood cholesterol levels.

Why is VHTG dangerous? 

Regardless of the cause, having very high triglycerides has been linked to a higher chance of developing heart disease and having a heart attack or stroke. While research is still underway to uncover the exact relationship between triglycerides and cardiovascular disease, we know that very high levels tend to cluster with other risk factors including being obese, high blood pressure, and high cholesterol

Studies find that very high triglycerides often occur along with:

  • Lower levels of “good” or HDL cholesterol that help clear cholesterol from the bloodstream
  • Smaller particles of the “bad” cholesterol that can speed up atherosclerosis
  • Changes to the body’s ability to break down blood clots, which can increase the risk of stroke
  • Metabolic syndrome 


Taken together, this can set the stage for serious cardiovascular problems.

Extremely high levels of triglycerides can also lead to pancreatitis, a very serious condition in which the pancreas becomes inflamed. This condition can cause significant pain and usually results in hospitalization. 

What is the usual treatment for VHTG? 

While studies about whether lowering triglycerides can measurably reduce the risk of heart disease or events are still ongoing, most experts say it’s best to keep them within the normal range. 

The goal of any treatment program will be to:

    1. Lower the amount of triglycerides in the blood
    2. Control conditions that can raise triglyceride levels (for example, obesity, diabetes, hypothyroidism, kidney disease) 

The best way to lower triglycerides is by making healthy lifestyle choices, which together can cut triglyceride levels by half! That means reducing triglycerides is partly within your control. 

Talk with your doctor about living healthier by taking these 4 steps:

1. Be more active—regular exercise can lower triglycerides and raise good cholesterol

2. Improve your diet—that means trying to:

  • Cut out excess calories by limiting unhealthy fats; dietary fat should only make up 25-35 percent of your total diet
  • Eat fiber-rich carbohydrates such as vegetables and whole grains and limit simple carbohydrates (white breads, pasta, potatoes)
  • Limit alcohol, which can cause triglycerides to spike in some people
  • Eat foods rich in Omega-3 fatty acids, available in certain fish (salmon, tuna, lake trout, and sardines), fish oil or flaxseed
  • Avoid refined sugars


3. Lose weight and stay at a healthy body weight—losing just 5-10 percent of your weight can lower triglycerides

4. Quit smoking and don’t start 

When it comes to lowering triglycerides, lifestyle modifications seem to work well and, in some cases, are as effective as taking medicine for lowering triglycerides. Taking the above steps will help you improve your overall health too.  

Lifestyle changes can have a profound effect on triglycerides, oftentimes getting them back in the normal range for many patients.

In some cases, your doctor may also prescribe medications to lower your triglycerides. These might include: 

  • Omega-3 fatty acids – prescription forms of high-dose omega-3 fatty acids that are naturally found in fish can lower triglycerides, but researchers don’t know exactly how yet. There are several FDA-approved omega-3 fatty acid formulations for VHTG; most include both EPA and DHA as active ingredients. These tend to be well tolerated and have been shown to reduce triglycerides by as much as 50 percent.
  • Fibrates – medications that work by impairing the liver’s ability to release triglycerides
  • Niacin or vitamin B3 – may work by reducing the activity of a chemical needed for the body to produce triglycerides.
  • Statins – used to lower LDL cholesterol and may also lower triglycerides 

As always, when taking medications:

Medication

Important Considerations/Side Effects

Omega-3 fatty acids

 

Only FDA-approved, prescription strength Omega-3 fatty acids should be used to treat VHTG. While there are dietary supplements (commonly referred to as "off-the-shelf"), these are not the same. 

People who have an allergy to fish or shellfish should not take omega-3 fatty acids. If you take the EPA and DHA combination, you may need to get your LDL cholesterol checked because DHA seems to raise this in some people. 

Swallow the liquid gel capsule whole and do not take it with a hot beverage. 

Tell your doctor if you notice any bruising.

Niacin

 

Immediate release formulations of this drug that work quickly in the body can sometimes result in flushing, itching, stomach upsets and raised blood sugar.

Fibrates

 

Dosages need to be adjusted for people with kidney problems. 

You should not take fibrates if you have liver and/or gallbladder disease. 

Taking statins and fibrates at the same time can make serious muscle problems more likely. This can lead to kidney failure.

Statins

 

Minimal, if any, positive effect on triglycerides, as research findings are mixed.

Tell your doctor if you also take fibrates.


*This table does not address all concerns or special considerations. Talk with your doctor about the pros and cons of all medications.

There are many new treatments being investigated as well. For example, there is growing evidence that flaxseed oil may help lower triglycerides in some people. As always, talk with your doctor about the right approach for you.

Questions to ask 

It’s always a good idea to be prepared to ask questions about any condition you have. The more you know, the more you can take proactive steps to take care of yourself. Here are a few questions to help get you started: 

  • How are triglycerides different from cholesterol?
  • What is my triglyceride level?
  • How often should this and my other cholesterol levels be checked?
  • Why do you think my triglyceride level is so high?
  • How can high triglycerides affect my heart health?
  • What is the best thing I can do to lower triglycerides?
  • What changes can I make to my diet that will help?
  • Do sugars cause high triglycerides?
  • How can I better control other risk factors for heart disease?
  • How is the prescription form of omega-3 fatty acids different from what I can get in the grocery store or pharmacy?

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