When it comes to the myriad risk factors for heart disease, few things top LDL cholesterol. A true bodily evildoer, this bad-boy lipid hogs all the media attention as a potential cardiac killer.
Meanwhile, triglycerides quietly accumulate in your bloodstream, systematically forming fat in your cells and wondering what havoc they must wreak to garner some notice. Triglycerides, in a way, are the Ringo Starr of lipids – essential to keeping the beat but hardly worth a second thought.
Sure, a few studies have confirmed that elevated triglyceride levels can be a strong predictor of cardiac trouble, stroke and heart disease. Left unchecked, they sometimes can result in acute pancreatitis, a life-threatening inflammatory condition.
But the so-called "bad cholesterol" – low-density lipoprotein, to be technical – remains of foremost concern to doctors because considerably more solid data exist, according to Kaiser Permanente Sacramento endocrinologist Dr. Laura Hoffman.
"With LDL, they have really good data that lowering (the levels in the blood) lowers risk," Hoffman says. "That's less so with triglycerides. The data is less firm."
That doesn't mean, however, that people should just ignore their triglycerides.
Rather, Hoffman says, a fasting lipid profile for triglycerides should be standard when checking a patient's cholesterol levels.
National Cholesterol Education program guidelines state that triglyceride levels should remain below 150 milligrams per deciliter. But some physicians, including those at the Mayo Clinic, recommend 100 milligrams. Levels between 200 and 500 are considered high and might merit aggressive intervention, and any number over 500 is a cause of immediate concern.
In those cases, most specialists go the medication route, prescribing either statins or fibrates to try to lower the numbers.
"But I'm a big advocate for (implementing) lifestyle measures first," Hoffman says. "We get away from that too much and go to the medication too quickly. Exercise and weight loss will give you the most satisfying decline in triglycerides."
Diet, of course, is crucial: Avoiding excessive refined carbohydrates, saturated fats and hydrogenated oil. As with treating cholesterol, try to consume omega 3 fatty acids (fish oils, for instance) and nuts and flax products. Niacin in vitamin B3 also has been shown to help.
One reason why triglycerides are not top-of-mind is that there are no obvious symptoms. In extreme and rare cases, Hoffman says, the body will break out in a rash. Most often, though, a patient might not notice any initial adverse health effects.
"The No. 1 cause still is excessive weight gain and a sedentary lifestyle," she says. "In normal amounts, triglycerides are a good energy source and a building block for cell membranes. It's just when it gets in excess when it's a problem. Same for LDL."
Many of Hoffman's patients have both elevated LDL and triglyceride levels. In such cases, she says, "as long as their triglycerides aren't dangerously high, we'll focus on LDL cholesterol first. We have better evidence that treating LDL will yield better outcomes."
See, triglycerides just can't get no respect.
Call The Bee's Sam McManis, (916) 321-1145.
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