Sometimes it seems like triglycerides are the neglected step-sibling of cholesterol. Despite being a standard component of most blood lipid panels, they’re often viewed by patients as an afterthought in discussions about cholesterol levels, a sort of also-ran shrouded in confusion and mystery. It’s a shame that triglycerides live in the shadow of total cholesterol, HDL cholesterol and LDL cholesterol, because they’re enormously important for our health. If you’re not paying attention to your triglyceride levels, you should be.

Another kind of lipid

Triglycerides are one of several fat-soluble molecules, or lipids, that have a considerable impact on our health. They may be found in fatty foods such as butter and cheese, but our bodies are also capable of producing them. When you eat more calories than you need, the digestive system converts that excess energy into triglycerides, which are then carried off and stored in fat cells. When the energy from those cells is needed by your body, it excretes a hormone to release the triglycerides from the fat cells.

Like other lipids, triglycerides travel through the bloodstream on lipoproteins, tiny spherical particles that combine proteins with lipids. So-called “good cholesterol” rides along on high-density lipoprotein (HDL), while “bad cholesterol” is transported via low-density lipoprotein (LDL). Triglycerides hitch a ride throughout the body on particles called chylomicron, “very-low-density lipoproteins” or VLDLs, or “intermediate-density lipoproteins” (IDL).

Unlike with HDL and LDL, you usually won’t see chylomicron, VLDL and IDL measures on your lipid panel results. Instead, you’ll get a reading simply labeled “triglycerides.” A normal rating is generally considered to be lower than 150 mg/dL. About a quarter of American adults have triglyceride levels higher than that, putting them at risk. A level of 200 mg/dL or higher puts you at 25% higher risk of dying from cardiovascular disease.

National Cholesterol Education Program Triglyceride Ranges

Less than 150 mg/dLNormal
150-199 mg/dLBorderline high
500 or greaterVery high

Remnant cholesterol

When they conduct blood tests of lipid levels, some doctors and laboratories use a measure called “remnant cholesterol.” This parameter can be helpful because it zeroes in on problematic substances that are dangerous even at low levels. It’s calculated by taking total cholesterol and subtracting out HDL and LDL. What remains are triglyceride-rich particles. People with high triglyceride levels usually show high remnant cholesterol readings, and are at increased cardiovascular risk. In fact, emerging evidence suggests that remnant cholesterol could be a more reliable predictor of atherosclerotic cardiovascular disease (ASCVD) than traditional cholesterol measures.

In fact, in 2015, Danish researchers studying 90,000 patients found that remnant cholesterol was a better predictor of all-cause mortality than LDL. And a 2021 Johns Hopkins-led study found that one in five patients with high remnant cholesterol scores (24 mg/dL or higher) would experience an ASCVD event during the 19-year follow-up period.

Health effects

What does it mean if your triglycerides are high? As you may already know, LDL (the “bad” cholesterol) causes atherosclerosis (a dangerous narrowing of the arteries) by sticking to and accumulating in the inner walls of blood vessels. But that’s not what triglycerides do. Their role in cardiovascular health is a bit more subtle. When triglyceride lipoproteins are broken down by the body, they’re metabolically “messy,” leaving behind what are called “remnant particles” including bits of cholesterol and other fatty acids. These particles can’t be used by the body, so it views them as foreign, stimulating an inflammatory response. And inflammation brings about physical changes to the arterial walls that invite cholesterol to stick and form plaques.

Triglycerides circulating in the bloodstream are closely associated with increased risk of cardiovascular disease (CVD). And in fact, when a person’s HDL levels fall and their triglyceride levels rise, their CVD risk doubles. Unfortunately, even if you get on medication to lower your LDL cholesterol, studies show that your risk of experiencing a major cardiovascular event remains high as long as your triglycerides are still elevated.

There appears to be a metabolic connection between triglycerides and HDL, with the two substances in an inverse relationship…as HDL goes up, triglycerides go down, and vice versa. Since high triglycerides alone are a risk factor for cardiovascular disease, their effect on HDL (the “good” cholesterol that helps rid the body of “bad” LDL cholesterol) packs a double wallop. And in fact, even if LDL levels look normal, someone whose HDL has fallen while their triglycerides have climbed is at increased risk.

Triglycerides are so closely tied to health that they’re one of the components of metabolic syndrome, a cluster of conditions which, taken together, dramatically increase risk of heart attack, stroke, and death. The other components are large waist circumference, low HDL, high blood pressure, and high blood sugar.

What causes high triglycerides?

Th most common reason for someone to have excessive triglycerides is that they regularly take in more calories than their body needs. Unsurprisingly, it often occurs alongside high blood pressure, insulin resistance, and abdominal obesity.

Other possible causes include:

  • Heavy drinking
  • Chronic kidney disease
  • Menopause
  • Hypothyroidism
  • Liver disease
  • Medications including corticosteroids, diuretics, and certain beta blockers
  • Pregnancy
  • Sleep disorders
  • Certain infections

How to lower triglycerides

The things you must do to lower your triglycerides are not especially different from what you must do to lower your cholesterol or to stay healthy overall. Don’t smoke, address any sleep issues, and drink moderately if at all. Every week, you should get 2.5 to five hours of moderate-intensity physical activity, with a particular focus on aerobic exercises (commonly called “cardio”). And eat a plant-based diet low in animal fats, such as the Mediterranean diet. The exception to animal fats is fish oil, which appears to lower triglycerides. Eat a couple of servings of oily fish such as salmon each week, or take a daily over-the-counter fish oil supplement.

If your triglycerides are dangerously high or don’t respond to these lifestyle changes, your doctor will likely put you on a cholesterol-lowering statin, and possibly on a prescription dose of a fish oil supplement specifically to target your triglycerides.

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