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Triglycerides: Are they important?

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By Kristine Scordo, PhD, RN, ACNP-BC, FAANP

The simple answer is YES! First, what are considered elevated triglycerides (TG)?  The AHA (American Heart Association) defines levels of triglycerides as healthy as less than 150 mg/dL; borderline high is 150 to 100 mg/dL; high is from 200 to 499 mg/dL and very high is 500 mg/dL or higher. Elevated triglycerides levels have been shown to be an independent risk factor for the development of cardiovascular disease, with severe hypertriglyceridemia associated with an increased risk of acute pancreatitis. TG levels reflect the presence of remnant lipoproteins that are thought to be responsible for the promotion of atherosclerosis.

Elevated TG levels can be primary or genetic, or secondary. Some secondary causes include alcohol, obesity, nephrotic syndrome, metabolic syndrome, Cushing’s disease and certain autoimmune diseases. Medications such as steroids and protease inhibitors can also elevate triglycerides.

Treatment usually focuses on therapeutic lifestyle change.  Avoiding alcohol and decreasing carbohydrate intake often lowers triglycerides. Secondary causes of hypertriglyceridemia, however, need to be initially ruled out and treated. When high levels are noted, look for diabetes or thyroid disease. Reducing serum glucose in individuals with diabetes mellitus will assist in lowering triglyceride levels. Medications that may cause elevated TG levels may need to be substituted.

Pharmacological treatment, in addition to intensive lifestyle modification, is usually required in patients with high TG levels–especially in those with a history of triglyceride-induced pancreatitis. Medications commonly used include fibrates, fenofibrates, niacin, Omega 3, statins and ezetimibe. Thus, just as we follow LDL (low density lipoprotein levels), practitioners need to follow and manage elevated triglyceride levels.

 

References

Miller, M., Stone, N., Ballantyne, C., Bittner, V., Criqui, M., Ginsberg, H., & Pennathur, S. (2011).
Triglycerides and cardiovascular disease: a scientific statement from the American heart association.     Circulation, 123(20), 2292-2333 42p.

Scordo, K. & Pickett, K. (2016) Triglycerides: Do they matter? American Journal of Nursing. January 2017 – Volume 117 – Issue 1 – p 24–31 Continuing Education Article

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