High Triglycerides And Risk Of Heart Attack

Triglycerides are fats that come from the diet or are manufactured by the body. High levels of triglycerides contribute to atherosclerosis. Very high levels of triglycerides can cause pancreatitis (inflammation of the pancreas). A new study shows that the more triglycerides you have in your blood, the greater your risk of having a heart attack. The major triglyceride-containing lipoproteins are called very-low-density-lipoproteins (VLDL), in contrast to the major cholesterol-containing lipoprotein LDL. In contrast, HDL (good) cholesterol is believed to carry cholesterol and other lipids from the arteries back to the liver.

High triglycerides are associated with a lot of other risk factors (low HDL, small dense LDL, obesity, diabetes), so it could just be "guilt by association" and not a causal relationship. We also have no evidence that lowering triglycerides reduces risk of heart attack. Nevertheless, persons at risk should do what they can to reduce their triglycerides: starting with reducing fat and simple sugars (fruit juices are a common problem), increasing exercise, and losing weight. If medication is needed, the most effective are fibrates and niacin. A new fibrate called fenofibrate is highly effective in reducing triglycerides. Some statins, such as atorvastatin or Lipitor, also reduce triglycerides, especially at higher doses.

The reasons why triglycerides increase a person's risk of heart disease remain unclear. High triglycerides are associated with low levels of HDL ("good") cholesterol and with increased amounts of small dense LDL, the worst form of LDL.

Researchers found an association between fasting triglyceride levels and heart attack risk, after adjusting for other risk factors, including HDL levels. Patients with high triglyceride levels were more likely to be males, diabetic, hypertensive, have a higher body mass index, have a higher level of physical activity, and drink more alcohol.

The ratio of triglycerides to HDL was a strong predictor of heart attack, suggesting a complex metabolic interaction between triglycerides and other lipids. High triglyceride levels appears to reflect a lower activity level of enzymes that break down fats in the blood, resulting in higher levels of VLDL and lower HDL levels, which are linked with increased heart attack risk.

Low-fat diets tend to elevate triglycerides and reduce the good HDL cholesterol, particularly if carbohydrates are substituted for fat. Only if these diets produce weight loss will the triglyceride levels usually decline. Some nutritionists suggest a right-fat diet instead of a low-fat diet; replacing saturated fat with monounsaturated fats can reduce the bad LDL without depressing HDL and raising triglycerides. Beer, wine, and hard liquor also elevate triglycerides; restriction of alcohol intake to no more than five to six drinks per week.

Your liver can change any source of excess calories - carbohydrate, fat or protein - into triglycerides. A triglyceride level of 250 mg/dl (milligrams per deciliter of blood) or less is considered normal. However, slight elevations of triglycerides, 250 to 500 mg/dl, often accompany other unhealthy amounts of fat in the blood.

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