My Doctor Says My Triglycerides Are High

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If your doctor tells you that you’ve got high blood triglyceride levels, what are the next steps? 

Triglycerides are the most common type of fat in the body. They supply much of the energy needed in everyday life, and they also account for the vast majority of fat stored in the human body. In fact, those layers of fat so many of us struggle to get rid of are comprised almost entirely of triglycerides. 

Triglycerides and Cardiac Risk

Triglyceride levels are measured by a routine blood test for lipid levels. Elevated fasting blood triglyceride levels are associated with an increased risk of heart attacks and strokes. Generally speaking, the higher a person’s triglyceride levels, the higher their risk. 

Also, people who have extremely high triglyceride levels also have a high risk of developing pancreatitis.

So if you have elevated triglyceride levels your doctor will probably want to lower them.

What You Should Know About High Triglyceride Levels

There are several potential medical causes for elevated triglycerides, including diabeteshypothyroidism, kidney disease, and medications including oral contraceptives and steroids. Some people also have genetic abnormalities that produce elevated triglyceride levels.

But by far, most people who have elevated triglycerides tend to also have associated risk factors that tend to be related to a poor diet, being overweight, and not getting very much exercise. These related risk factors are reduced blood levels of HDL cholesterol (“good” cholesterol), insulin resistance, and hypertension. With this constellation of risk factors, the precise contribution of high triglyceride levels to overall cardiovascular risk is difficult to tease out — but people who have such a profile are at a substantially elevated risk for heart attacks and strokes. 

Treating High Triglyceride Levels

If your doctor has recommended reducing your triglyceride levels, you will need an evaluation to find out why. In particular, you will need screening tests to look for diabetes, thyroid disease and kidney disease, and if any of these conditions are found, they will need to be treated. With adequate treatment, your triglyceride levels will improve.

For most people with high triglyceride levels, however, reducing those levels will require lifestyle changes. Lifestyle changes that will help to reduce your triglyceride levels include:

  • Dietary changes. A heart-healthy diet, the type of diet that anyone with either cardiovascular disease or with elevated cardiovascular risk should follow, will help to reduce your triglyceride levels. To follow a heart healthy diet, you should eliminate sugar and processed foods (which often contain sugars and unhealthy fats) from your diet, and eat plenty of fruits and vegetables, use whole grains instead of processed grains, eat foods containing omega-3 fatty acids (especially fish at least twice per week) and monounsaturated fatty acids (like olive oil). Lean meats are OK a few times per week, but alcohol (which can greatly increase triglyceride levels) should be limited to no more than a drink or two per day. A Mediterranean-style dietincludes all these features.
  • Weight control. You should work toward reaching and maintaining a healthy weight. 
  • Exercise. Exercise 30 minutes a day to ward off heart disease and 60 to 90 minutes a day to also lose weight. 
  • Quit smoking
  • Review your prescription medication. Discuss with your doctor whether you are taking prescription medication that is known to increase triglyceride levels.

    What About Triglyceride-Lowering Medication?

    If your triglycerides are very high (500 mg/dL or more), your doctor will need to treat you with medication to avoid potentially dangerous pancreatitis. In fact, preventing pancreatitis is the main reason drugs are prescribed for elevated triglyceride levels. This is because there are no solid clinical trials clearly demonstrating that drug therapy for high triglycerides will substantially reduce cardiovascular risk. 

    At the same time, there are studies that have suggested (though not proven) a benefit from drug treatment. So, if your triglyceride levels remain substantially elevated even after you have incorporated all the lifestyle changes that your doctor has recommended, medication may become a reasonable idea. 

    When levels are somewhere between borderline high and the low end of high (150 to 200 mg/dL), and are not joined by other serious conditions, it’s possible to decrease triglycerides without drugs. But most people need medications, such as:

    • Fibrates: These include gemfibrozil ( Lopid ) and fenofibrate ( Tricor ). Fibrates work best to lower triglycerides but can interact dangerously with some cholesterol-lowering drugs
    • Niacin: Take prescribed niacin only. Over-the-counter supplements may have too much or too little and there are possibly serious side effects that you should discuss with your doctor.
    • Omega-3 (n-3) fatty acids: You can get these good fats in your diet or you can get high doses in a fish oil supplement or by prescription.
    • Statins: Statins are very effective at lowering cholesterol, but they only work to lower mildly elevated triglycerides.

    Bile acid sequestrants, which reduce cholesterol, can actually raise triglyceride levels.

    A Word From Verywell

    Triglycerides, the most common form of fat in the body, are vital to normal life. However, high blood levels of triglycerides are now strongly associated with an elevated risk for cardiovascular disease — and are also usually accompanied by other important cardiac risk factors. If you have high triglyceride levels, you need to work with your doctor to take steps to lower them. Usually this involves changes in lifestyle, but if your blood levels are very high drug treatment might also be recommended.

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