Triglycerides and cholesterol

  My husband was just informed that his triglyceride level is 408 and cholesterol is 230.  His doctor wants him to start taking Lipitor.  He is 43 years old, non-smoker, non drinker and is not overweight.  There is no history of heart disease in his family that I know of.  I always thought cholesterol was a better indicator for heart problems, rather than triglyceride.  An LDL and HDL was not performed at the time.  Is the doctor being overly cautious about this situation?  We were told to just have him reduce the amount of fried foods he eats, nothing else.  What about sweets that are high in fat, cheeses, etc?  It doesn't seem like he warrants taking this medication.  What is your opinion?

[CCF Cardio MD - MTR]

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Dear Barbara, thank you for your question.  There is ample data now from large clinical trials that conclusively proves that aggressive cholesterol reduction with medications reduces long-term mortality and heart attacks in people with no established coronary artery disease.  Ideally, in this population of patients, the LDL cholesterol  should be below 130 and the total cholesterol should be below 200.  Diet and exercise at best will reduce cholesterol levels by 15%.  Triglycerides have not been studied as thoroughly as cholesterol but there is growing evidence that high triglyceride levels (> 200) are independently associated with adverse cardiac outcomes.  Lipitor is a relatively new cholesterol-lowering agent that also lowers triglycerides (unlike the other available agents).  I think your husband should also have his HDL and LDL cholesterol levels measured before starting Lipitor, but that this medication will certainly benefit him in the long run (next 20-30 years).  He also needs to concurrently exercise daily (30-45 minutes of moderate intensity aerobic exercise) and eat a low fat, low cholesterol diet (avoid the sweets you mention).  This strategy will give him the best long-term chance of avoiding a heart attack and coronary artery disease. However, you could argue that these risks appear only theoretical in his case at this point.  Thus, I think he should visit with his physician again to discuss these issues more thoroughly and to have his HDL and LDL cholesterol levels measured.  Good luck!
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