Everyone knows about cholesterol. A lot of us also know about high density lipoproteins (or HDL) and low density lipoproteins (or LDL), but a third type of cholesterol is often overlooked; the triglycerides.
Cholesterol is a waxy substance that accumulates in blood vessels. There, it can cause the narrowing and blockages that increase the risk for angina or heart pain, heart attacks, and even, in some cases, strokes.
HDL is “good” cholesterol that is able to attach to cholesterol and remove it from vessels, while LDL is “bad” cholesterol that builds up in the vessel walls causing plaques. Blood tests are used to measure total cholesterol and to check HDL and LDL levels.
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Triglycerides, which are related to cholesterol, are also analyzed with blood tests, usually at the same time, and ideally, they should measure less than 1.7 mmol/L. As the term suggests, this type of cholesterol contains a glycerol component and three fatty acids and they are either obtained from the diet or manufactured in the liver. Triglycerides are the main component of body fat; when excess calories are eaten, they are stored as triglycerides.
Of the 40 per cent of Canadians who have elevated cholesterol levels, a quarter will have elevated triglyceride levels.
Risk factors for high triglyceride levels include obesity, a metabolic syndrome which is a foreshadower of diabetes, type 2 diabetes, excessive alcohol use and inactivity. The risk factors overlap each other in that several are also risk factors for being overweight. Some drugs are associated with high levels of triglycerides, for example beta blockers, steroids, estrogens, immunosuppressant drugs, isotretinoin for acne, and thiazide water pills. Obviously good control of any underlying condition, maintaining a healthy weight, and checking medications for potential problems are ideal approaches to avoid high triglyceride levels.
As with all types of cholesterol the risk for cardiovascular disease is associated with high triglyceride levels, but with severely elevated levels inflammation of the pancreas (i.e. pancreatitis) can occur. Unfortunately, high cholesterol or high triglyceride levels do not have symptoms. It makes sense to have levels checked regularly for early diagnosis and treatment.
The same medications used to treat other types of elevated cholesterol will work with elevated triglycerides, and the drugs of first choice are the statins, that is atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin. They block the body’s manufacture of cholesterol. Atorvastatin and rosuvastatin are considered high potency statins and can be taken any time during the day, but the other statins are best taken later in the day so that blood levels are higher overnight when the body manufactures much of its cholesterol. Myalgias or muscle aches and pains are potential adverse effects, but switching to a lower potency or a dose reduction may solve these problems.
Fibrates such as fenofibrate or gemfibrozil increase the speed with which dietary cholesterol moves through the body, and ezetimibe blocks the absorption of dietary cholesterol. Both are often used in combination with statins, but with triglycerides the addition of a second drug has only a small effect.
Another drug that is effective in reducing triglycerides is niacin, but severe facial flushing limits its use. Omega 3 fatty acids do not seem to have a significant effect on triglycerides, and because these are obtained from cold water fish a fishy aftertaste can be unpleasant. However, in cases where there is pancreas involvement a combination of medications is often used to prevent pancreas damage.
Elevated cholesterol level conditions including hypertriglyceridemia are asymptomatic, thus laboratory tests are needed. However, eating a healthy diet, maintaining an ideal body weight, exercising regularly and consuming alcohol in moderation will help keep cholesterol levels within normal ranges.
