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DOCTORS TALK TRIGLYCERIDES

By Dr. George V. Roberson/FOR YOUR HEALTH
Monday, March 2, 2009 9:55 AM CST

Q: I am recovering from a heart attack. My cholesterol is under control with Zocor, low fat diet and exercise. However my triglycerides are high at 245. I’m not sure how to lower them and would appreciate your advice.

A: Although there is some evidence that elevated triglycerides in certain incidences are associated with atherosclerosis, there is controversy about the method of treatment or if further treatment should be focused on elevated triglycerides at all. Physicians have focused on elevated cholesterol because of strong evidence of association of atherosclerosis in response to treatment.

Triglycerides in a male, age 30 - 39, may normally vary anywhere from 49 to 284 milligrams per dl. Between the ages of 40 - 49, triglycerides are still considered normal if it falls in the range of 56 - 298 milligrams per dl. About the same range exists for males aged 50 - 59. It would appear your physician has focused on lowering your serum cholesterol. Perhaps more important than the level of triglycerides would be the ratios of HDL (high density lipoproteins) and LDL (low density lipoproteins). These are the “good HDL” and “bad LDL” cholesterol. Most laboratories and physicians break down the total cholesterol down into subsets as they appear to have a high predictive level of atherosclerotic outcome.

Hyperlipidemia is the elevation of plasma, cholesterol and or/triglyceride concentrations. Generally it is associated with triglyceride elevation. In recent years lipoproteins have been separated into different units and classified by high speed centrifuge and electrophoresis. Triglycerides and cholesterol are transported around the body by varying spectrums of lipoproteins. These proteins have been identified in certain disease sets and some are associated with genetic defects.

About one percent of individuals have two sets of genes leading to abnormal overproduction of triglycerides and a defect in the metabolism or breakdown of triglycerides.

There is also a familial lipoprotein lipase deficiency. There is absence of an enzyme that breaks down the triglycerides leading to massive hyperglyceridemia.

There is also familial hyperglyceridemia which is also a genetic defect. The liver tends to synthesize too much triglyceride. Individuals with this disorder do not appear to have an increased predisposition for heart disease and remain relatively asymptomatic.

There are other diseases associated with hypertriglyceridemia. These include diabetes, chronic uremia, obesity, alcohol abuse, and hypothyroidism.

Therapy is aimed at correcting hyperlipidemia by controlling underlying disease states. The goal is to prevent progression of atherosclerosis in some individuals with specific lipoprotein abnormalities. Young individuals who may be at risk can often be identified by family history of premature coronary artery disease in their parents.

Most of the time physicians tend to focus on cholesterol elevations and treat it with low saturated fat low cholesterol diets and medications such as Zocor. Exercise is beneficial. The total cholesterol level and ratios of HDL and LDL are the important indicators that most physicians base their therapy on. It is not specifically the triglycerides. A triglyceride level of 245 remains within normal limits for patients after the age of 40.

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