When it comes to heart disease risk, most people are aware of the threat high cholesterol poses—in fact, nearly one in three American adults over age 40 takes medication to help control his/her cholesterol…and new guidelines were recently ­announced to provide better cholesterol management. 

What you may not know: According to the latest research, high triglycerides are just as threatening to your heart. But  unfortunately, they’re frequently downplayed by doctors and their patients.

Background: In prehistoric times, triglycerides (fats, also called lipids, in the blood) were a way for our hunter-gatherer ancestors to store fat—a must when food was sparse and famine common. But the stored fat that saved our ancestors from starvation is killing us now. 

Fatty, sugary food is superabundant, and we eat too much of it. As a result, more than 70% of adults in the US are overweight or obese—which means they’re storing harmful amounts of triglycerides that increase risk for cardiovascular disease.

Up until now, scientists had not proven that lowering triglycerides also lowers the risk for cardiovascular disease…

Important new finding: In a study published in The New England Journal of Medicine, researchers looked at more than 8,000 patients with heart disease, diabetes and other risk factors for heart attack and stroke. All participants were taking a statin, and their low-­density ­lipoprotein (LDL) “bad” cholesterol was at a healthy level (below 100 mg/dL). However, they still had high triglyceride levels. 

Adding a triglyceride-lowering drug to their regimen—4 g of icosapent ethyl (Vascepa), a highly purified fish oil that delivers the healthful omega-3 fatty acid EPA—lowered triglycerides by 20% compared with a placebo. Over the six-year study, first-time heart attacks were reduced by 31% and strokes by 28%, and there were 20% fewer deaths from cardiovascular disease in patients taking the triglyceride-lowering drug. Additionally, the level of C-reactive protein, a biomarker for artery-damaging ­inflammation, was reduced by an average of 20%.* 

In follow-up research, the results were even better—there was a 30% reduction in the combined rate of first as well as second and subsequent cardiovascular deaths, nonfatal heart attacks or strokes, procedures such as stenting and hospitalization for unstable angina.

Bottom line: The higher your level of triglycerides, the higher your risk for cardiovascular disease. Based on this new research, lowering high triglycerides will likely become standard practice to curb risk for and treat cardiovascular disease. 

Get Your Levels Tested

A normal triglyceride level is generally below 150 mg/dL. But research shows that about one-third of Americans have triglycerides in the danger zone—­150 mg/dL and above. 

To get your levels tested: Your doctor should order a blood test to measure all blood fats that impact the heart, including total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. Apolipoprotein B levels, which measure the number of potentially harmful particles that carry cholesterol and triglycerides, are often measured as well. The frequency­ of testing depends on the age and cardiovascular risk of the patient.

While triglyceride levels have previously been measured in standard blood tests, doctors didn’t realize their importance in the treatment of cardiovascular disease.  

If Your Triglycerides Are High…

Several classes of medications can raise triglyceride levels. For example: Beta-­blockers and diuretics (used for high blood pressure)…estrogen (for menopause)…retinoic acid and retinoids (for psoriasis and other skin problems)…and bile acid sequestrants (used mainly for lowering cholesterol). If you’re taking any of these drugs and your triglycerides are high, your doctor may change the dose or prescribe an alternative drug. 

Other risk factors for high triglycerides that your doctor should check for include prediabetes and diabetes, kidney disease, thyroid disorder and a family history of very high triglycerides. If an underlying condition is treated, high triglycerides can be resolved. 

If the above causes have been ruled out, under the guidance of your doctor and for the amount of time he/she suggests, try the triglyceride-lowering lifestyle plan below. This healthy plan is also a good way to help protect against developing high triglycerides.

Eat a Mediterranean diet. The main reason for high triglycerides is a poor diet—namely one that emphasizes processed foods, trans fats (found in baked goods and fried foods), saturated fat (found in meat and dairy products) and sugar and refined starches. Your best strategy is to eliminate or minimize your intake of all these types of foods. 

To keep triglycerides under control, I favor the Mediterranean diet, which is rich in vegetables, fruits, whole grains, beans, nuts and seeds, fish and olive oil. In a study published in Journal of Nutrition, people who followed a Mediterranean diet for six months had a significant reduction in triglycerides compared with people who ate their usual diet. 

Exercise regularly. Regular exercise lowers triglycerides…LDL cholesterol…inflammation…and stress hormones. It also helps control weight, a risk factor for high triglycerides. To start, aim for 20 minutes of moderate exercise (like brisk walking), three to five times a week. Over time, increase to at least 30 minutes, five times weekly. In a recent study published in Journal of Clinical Lipidology, daily 30-minute walks lowered triglycerides. 

Get seven to eight hours of sleep every night. A new animal study from Japan and published in American Journal of Physiology—Endocrinology and Metabolism shows that sleep deprivation increases triglycerides. In a similar study, people with sleep apnea—a disorder in which breathing repeatedly stops during sleep—had higher triglycerides than those without this sleep condition. Sleep apnea is linked to increased cardiovascular disease and is best treated with a continuous positive airway pressure (CPAP) device. See a sleep specialist for advice.

Discuss medication. If the lifestyle measures above don’t adequately lower your triglyceride levels, talk to your physician about medication, such as a statin, fibrate and/or the prescription omega-3 fatty acid Vascepa. It’s currently FDA-approved only for patients with triglycerides of 500 mg/dL and above (this level can cause pancreatitis, a potentially life-threatening disease that must be treated). Given the new clinical trial data with Vascepa, it is likely that it will soon be FDA-approved for people at high risk for cardiovascular disease who have well-controlled LDL cholesterol on statin therapy but continue to have triglyceride levels of 150 mg/dL and above. Note: Vascepa is pharmaceutical grade and is not the same as the omega-3 fish oil supplements that you can buy in the store. 

*The research was sponsored by Amarin, the manufacturer of Vascepa.

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