Re: triglycerides

Posted By CCF CARDIO MD - CRC on August 31, 1998 at 09:27:06:

In Reply to: triglycerides posted by Jeanine Barone on August 30, 1998 at 16:30:22:






I'm a healthy, athletic, 40 year old woman (non smoker, non drinker and underweight for my height). I just had my blood lipids measured for the first time and was told everything was fine. But when I asked for the numbers, my physician said: TC 150, HDL 40, ratio: 308 and TG 500!! I freaked out but he said there was nothing to worry about and simply suggested my having a retest in 2 weeks. I don't have a family history of premature CHD and I don't know what to do with this information. I'm very opposed to medication. My diet is already low fat, low cholesterol and I eat fish at least twice a week. My question is: am I at significant risk of CHD because of this blood profile. And is there anything I can do aside from meds? Thanks.






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Dear  Jeanine,
Thank you for your question.  I have written some detailed information about cholesterol for you below but the bottom line is that the role of triglyceride is not well established and is probably not that significant.  The triglycerides can be falsely elevated by eating so when you get the repeat test it should be done in the fasting state.  Hope this helps.
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.  
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.
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.