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High Triglycerides Treatment Options

Content provided by: Better Medicine from Healthgrades

If you have been diagnosed with high triglyceride levels, you need to get those levels back to normal. Triglycerides are fats that circulate in your blood and get stored in your fat cells. High levels of these fats increase your risk for heart disease, stroke, and a dangerous swelling of your pancreas called pancreatitis.

Selecting the best treatment for your high triglycerides depends on what your numbers are. Triglycerides are measured in milligrams per deciliter (mg/dL). Here are the possibilities:

  • Less than 150 means you are in the normal range.

  • Between 150 and 199 means you are borderline high.

  • Between 200 and 499 means you are too high.

  • 500 or higher means you have very high triglycerides.

Treatment Options for Triglycerides From 150 to 199

If you are in this borderline area, your doctor may do tests to see if you have metabolic syndrome. Metabolic syndrome is a combination of conditions that increase your risk for heart disease and type 2 diabetes. This condition can include high triglycerides, high blood pressure, increased belly fat, low HDL (good cholesterol), and high fasting blood sugar. Your treatment plan might include:

  • Counseling to help you improve your diet, lose weight, stop smoking, and start exercising

  • Better management of your diabetes, if you have diabetes

  • Losing 5 percent of your body weight

  • Having your risk for heart disease evaluated

  • Lowering your bad (LDL) cholesterol

You may need to take a statin drug, such as Lipitor or Crestor, to lower your bad cholesterol if you have a high risk for heart disease or you have diabetes. Studies show that taking a statin drug can also lower your triglycerides by about 20 to 40 percent.

To evaluate your 10-year risk for heart disease, your doctor may use the Framingham risk calculator. To do this risk study your doctor will take into consideration factors such as your age, smoking history, diabetes history, blood pressure, total cholesterol, and bad cholesterol.

Treatment Options for Triglycerides Between 200 and 499

For high triglycerides you may be given all the same counseling, evaluations, and treatment options as for borderline triglycerides. Additional options may be needed if your LDL cholesterol goals have not been met or if your doctor feels you are at high risk for heart disease. These options may include:

  • Switching to a statin drug with better triglyceride lowering properties

  • Combining a statin drug with a fibrate drug

  • Combining a statin with niacin

  • Combining a statin with fish oil

Fibrate drugs can lower triglyceride levels by 40 to 60 percent. Fibrate drugs include Tricor and Lopid. Niacin is a B vitamin that has been shown to lower triglyceride levels by 30 to 50 percent. Fish oil capsules contain omega-3 fatty acids, which are healthy fats that can reduce triglycerides by 30 percent. However, a number of studies have not shown clinical benefit (e.g., prevention of heart attacks) when combining statins with other drugs despite some improvement in cholesterol and triglycerides levels. As a result, some doctors feel the risk of side effects outweighs any potential benefits.

Treatment Options for Very High Triglycerides Above 500

If your triglyceride level is above 500 you will probably need to take a fibrate or niacin along with all the other options for high triglycerides. Here are some other options:

  • A very low-fat diet to decrease your risk for pancreatitis if triglycerides are above 1,000

  • Significant weight loss

  • A combination of fibrate, niacin, and fish oil to get triglyceride level down below 500

If your triglycerides are above 500, your doctor will direct therapy towards this first and then target your LDL once triglycerides drop.

If you don't know your triglyceride level you should have a complete lipid profile done. The National Cholesterol Education Program advises that everyone have a lipid profile done every five years starting at age 20. A complete profile includes triglycerides along with your cholesterol levels. If you have borderline or high triglycerides, work with your doctor to start getting your triglycerides under control.

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Patients with triglycerides in the very high range (over 500 mg/dL) generally will require medications, because triglyceride levels this high may cause other medical problems.