Re: Triglyceride medication?

[D-Smith]

Posted By D Smith on May 20, 1999 at 11:46:03
I had a triglyceride test last fall and it read 700 +.  I started to take gemfibrozil for a few months but discontinued it due to mild stomach discomfort.  I then started to exercise more and eat better.  Now, I recently had the TGs measured and they are 289.  I know this is still high, but, do I need to start to take the gemfibrozil again?  OR, do I still need more improvement in my diet and do I need to increase my exercise program?  Also, at what # or level would one have to start medication, ie 500, 600?  Also, how much fat grams and cholesteral should I have in my daily diet.  Thanks for all responses...

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 20, 1999 at 13:15:37

Dear D.,
Thank you for your question.  First of all let me say that information presented here is not intended to replace the advice of your personal physician.  He/she is the one who knows your particular case the best and will make recommendations that are specific to you.  So I would recommend following your doctors advice for treatment questions.  I have given you some general information below.
Cholesterol has been identified as a major risk factor in the development of heart disease.  Early studies established high cholesterol as a risk factor for developing heart disease.  Lowering cholesterol for secondary prevention, that is preventing second heart attacks in persons who already had had one, was next demonstrated in the eighties and primary prevention of heart attack and stroke (In persons who had never had a prior event) demonstrated in the nineties.  The most recently published studies have demonstrated that lipid lowering therapy decreases cardiac events even in those persons with normal cholesterol.
Total cholesterol is broken down into different categories.  High density cholesterol (HDL) is the good cholesterol that acts as a cleaning cholesterol.  Low density cholesterol (LDL) is the bad cholesterol that clogs up arteries throughout the body.  LDL is not usually measure directly but is calculated from the following equation: LDL=Total-HDL-triglycerides/5.  If the triglycerides are too high the LDL calculation is not valid.  Triglyceride is another type of cholesterol whose significance is not well established.  Very high levels (>1000) can lead to pancreatitis and other health problems.   Cholesterol should be measured after an 8 hour fast.
Guidelines have been established as to the treatment of high cholesterol.  It has been recommended that everyone over that age of 25 has their total cholesterol and HDL measured.  If these are abnormal a full cholesterol panel should be done.  Guideline for the treatment of cholesterol depend upon the risk factors that the person has.  Risk factors are a family history of heart disease, high blood pressure, male >45 yrs or female >55 yrs, diabetes (counts as two risk factors), smoking and obesity.  Someone at low risk should have a goal LDL cholesterol less than 130 and should be on a special diet if LDL is greater than 160 and on medication if it is  greater than 190.  Someone with one or two risk factors should start medical treatment at 160.  Someone with more than two risk factors or with established heart disease should have a goal LDL of less than 100 with medical treatment started at 130.
Medical treatment of cholesterol includes resins which bind cholesterol, niacin, gemfibrazole (useful for elevated triglycerides) and statins.  All of the drugs except the resins may have a negative effect on the liver and liver function tests should be monitored.  If there is an increase in the liver enzymes it is usually reversible if the drug is stopped.   A rare but potentially serious side effect is myositis (muscle inflammation) and if muscle pain should occur the drug should be stopped and the prescribing doctor notified.
Q: What would cause a decline in HDL levels over a five year period?
A: HDL levels are effected by mainly by exercise and genetics.  Increasing exercise increases HDL levels and decreased exercise lowers HDL levels.
Q:  Is there anything that has been known to increase HDL?
A: Exercise has been shown to increase HDL levels as has small quantities (1/2 glass) of daily red wine.  Niacin is the best drug therapy to increase HDL but it must be taken in sufficient quantities (i.e. 2- 4 grams per day) to have an effect.
Q: How serious at risk factor for heart attack/stroke is a low HDL?
A: In recent years it has been recognized that a low HDL is a more serious risk factor than was previously thought.  The current recommendations is that a low HDL be aggressively treated to reduce the risk for heart attack.

Further information can be found at the site below:
http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/chol.html
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.











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