Sadiya Khan, MD
Sadiya Khan, MD, the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine.
Cholesterol numbers and their significance often take center stage in discussions about cardiovascular health. However, there’s another number that tends to fly under the radar but can be just as important: triglyceride level. These two measures together provide valuable insights into an individual’s risk for heart disease.
Cholesterol and triglycerides are both types of lipids, or fats, circulating in the bloodstream. They play pivotal roles in various bodily functions, but when their levels become imbalanced, particularly in the context of heart health, problems can arise. Higher cholesterol and triglyceride numbers are associated with a higher risk of heart disease. However, the interpretation can be more nuanced.
Triglyceride numbers over 150 milligrams per deciliter (mg/dL) are associated with a higher risk for heart disease, but lowering them doesn’t necessarily reduce that risk. They could simply be a marker, and not a cause, of cardiovascular risk.
Elevated triglycerides could represent obesity, uncontrolled diabetes, or lifestyle factors like excessive alcohol consumption and a high-calorie diet. Triglycerides, often overshadowed by cholesterol, can serve as early warning signs.
Last year, the published results of the PROMINENT (Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients with Diabetes) trial showed that a medication called pemafibrate lowered high triglyceride levels but was not associated with a lower risk for cardiovascular events. These findings prompted some professionals to question whether treating high triglycerides is beneficial.
There are two possible explanations for the study’s findings: First, the lower triglyceride level didn’t equate to lower risk because triglycerides are a marker, not a cause, of heart disease. The second possibility is that the way that pemafibrate lowers triglycerides was not effective at lowering the risk of heart disease.
One of the best ways to lower heart disease risk—which may also lower triglycerides—is to focus on diet and physical activity.
The American Heart Association emphasizes the importance of adopting healthy dietary patterns rather than simply focusing on eliminating fats or carbohydrates. The Mediterranean diet, for example, has gained recognition for its heart-protective benefits. (Visit www.bottomlineinc.com for more on this dietary plan.)
Physical activity, too, is a potent tool. Incorporating a little more movement into daily routines, like parking farther away or using step counters, can make a significant difference. Even if you’re not currently meeting the recommended 150 minutes per week, every bit of additional movement counts. The key is to gradually increase activity levels from where you currently are. Any exercise is better than none. (See the cover story on how exercise can also reduce the risk of dementia.)
For some individuals, lifestyle changes might not be sufficient, and a physician may recommend trying medications to bring triglyceride levels down. Statins, a class of cholesterol-lowering drugs, are widely prescribed for high cholesterol and have demonstrated effectiveness in reducing heart disease risk, so they should always be first line to lower risk for heart disease.
A newer drug, icosapent ethyl (Vascepa), specifically targets high triglyceride levels. Its use is generally reserved for individuals with established heart disease or diabetes who are already on statin therapy. Vascepa can have side effects, such as muscle pain or swelling in the extremities.
Regular health check-ups often include cholesterol and triglyceride measurements. Keeping track of these numbers over time provides valuable information about your heart health trajectory. If you’re concerned about your levels, discussing them with a health-care provider can lead to a comprehensive plan that considers your heart-disease risk and specifically targets lipid levels and diabetes risk.
Cholesterol and triglycerides are more than just numbers on a report: They are key indicators of heart health. While cholesterol tends to hog the spotlight, triglycerides offer essential insights into metabolic health. Understanding these numbers, making lifestyle adjustments, and, if necessary, seeking medical intervention can contribute to a heart-healthy life.
Triglyderides are measured with a blood test. You should not eat for eight to 12 hours before the test, and avoid alcohol. Some over-the-counter drugs, supplements, and medications can interfere with blood test results. Your doctor will tell you what you’ll need to stop taking before the test.
Your results will fall into one of three categories:
