The Link Between Triglycerides and Heart Health

Triglycerides are the most common form of fat in the body. In fact, almost all the excess calories you consume, whether you get them from eating fats or eating carbohydrates, are converted to triglycerides and stored in your fatty tissues.

How Triglyceride Levels Relate to Cardiovascular Risk

An elevated level of triglycerides in the blood (a condition referred to as hypertriglyceridemia) is now known to be associated with an increased risk of cardiovascular disease—in particular, heart attacks and strokes—in both men and women. Furthermore, people with both coronary artery disease (CAD) and elevated triglycerides have a higher risk of premature death than people with CAD and normal triglyceride levels.

High triglyceride levels, furthermore, are strongly associated with other significant lipid abnormalities, including low HDL cholesterol levels, small, dense LDL particles, and insulin resistance. Insulin resistance, in turn, is associated with hypertension and obesity and is thought to be an underlying cause for type 2 diabetes. Thus, high triglyceride levels are most often seen in people who have a very high-risk metabolic profile. In these people, a high incidence of cardiovascular disease is not surprising.

Classification of Triglyceride Blood Levels

Triglyceride blood levels are classified as follows.

• Normal triglycerides: less than 150 mg/dL
• High: between 150 and 499 mg/dL
• Severe: above 500 mg/dL

Causes

Elevated triglyceride levels are most commonly seen in people who are overweight and sedentary, and who also have a tendency toward insulin resistance or overt type 2 diabetes.

Other conditions associated with high triglyceride levels include:

• Hypothyroidism
• Kidney conditions, especially nephrotic syndrome
• Pregnancy
• Medications, including estrogen replacement, tamoxifen, and some beta blockers

In addition, several genetic conditions have been identified that are characterized by elevated triglyceride blood levels. These include chylomicronemia, familial hypertriglyceridemia, familial dysbetalipoproteinemia, and familial combined hyperlipidemia.

Each of these genetic disorders is characterized by abnormalities in the lipoproteins that carry triglycerides in the blood. People with genetically mediated elevations in triglyceride levels may suffer from the consequences of hypertriglyceridemia (pancreatitis or cardiovascular disease) even if they are not overweight or sedentary.

Treatment

The recommendations for treating hypertriglyceridemia are not as definitive as the recommendations for treating high cholesterol. As a result, if you have high triglyceride levels, you'll need to discuss treatment options with your healthcare provider.

The lack of definitive treatment recommendations stems from the fact that, while elevated triglycerides have been associated with an increased risk of cardiovascular disease, evidence that you can reduce the risk specifically by aggressively lowering triglyceride levels is lacking. This, in turn, is related to the fact that most people with hypertriglyceridemia also have several other risk factors—and in most people, all the risk factors get treated at the same time. It’s next to impossible to tell how much of the improvement in outcomes are related specifically to lower triglyceride levels. 

While there are no firm treatment directives, the following are some general guidelines for treating hypertriglyceridemia.

• For triglyceride levels in the borderline high range, lifestyle modification is recommended, including diet (avoiding saturated fats and trans fats, eating plenty of fruits and vegetables, and avoiding alcohol), weight loss, exercise, smoking cessation, control of blood sugar, and blood pressure control.
• For triglyceride levels in the high range, the same lifestyle modifications are recommended, along with a reduction in LDL cholesterol levels, according to the latest recommendations for treating LDL cholesterol.
• For triglyceride levels in the very high range, according to the latest recommendations for treating LDL cholesterol, the primary goal is to prevent pancreatitis by reducing triglyceride levels to below 500 mg/dL (usually with a fibrate drug or niacin), then secondarily to aim for LDL cholesterol reduction.

If very high triglyceride levels fail to respond to lifestyle changes and treatment with a fibrate or niacin, adding high-dose marine omega-3 fatty acids (fish oil) can further reduce triglycerides. However, because the usual fish oil supplements contain less than 50% omega-3 fatty acids, in order to reliably reduce triglyceride levels, prescription forms of fish oil are often used. These prescriptions (Lovaza and Vascepa) contain a high concentration of omega-3s.

A Word From Verywell

Elevated triglyceride levels are associated with high cardiovascular risk, and extremely high triglyceride levels can cause pancreatitis.

In most people, high triglyceride levels occur within a setting of multiple risk factors for heart disease. Therefore, if you have high triglyceride levels, odds are good that your cardiac risk factors present a "target-rich environment." You and your healthcare provider should work together to devise a personalized risk-reduction strategy that's right for you.