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Tackle triglycerides for better heart health.

While LDL ("bad" cholesterol) and HDL ("good" cholesterol) are common health topics, triglycerides--fats that circulate in the blood--get less press coverage. But just like high LDL and low HDL, high triglyceride levels increase your risk of cardiovascular disease. According to a 2015 study, triglyceride levels have been dropping in the U.S., particularly among adults age 60 and older. However, a substantial number of seniors are still living with unhealthy triglyceride levels. "Triglycerides, like LDL, contribute to plaque formation in the arteries," confirms Mount Sinai cardiologist Bruce Darrow, MD, PhD. "Plaque buildup can narrow or clog arteries, or rupture and provoke blood clot formation, which can cause a heart attack or stroke."

What are triglycerides? When you eat, the calories that aren't immediately converted into energy are instead converted into triglycerides and stored until the body needs them. The "storage facility" for triglycerides is intra-abdominal fat, which is located behind the muscles and around the internal organs in your abdominal area.

Triglycerides move into and out of storage via the bloodstream, and are gradually whittled down in size as they circulate. Eventually they become so small they can get under the lining of the arteries and cause plaque formation--but that isn't all they do. As the amount of triglycerides in the bloodstream increases, they also affect HDL. "When triglyceride levels go up, you usually get drops in healthy HDL cholesterol," Dr. Darrow confirms. "What this means is that lowering LDL levels alone doesn't completely reduce the risk of cardiovascular events such as heart attack and stroke unless high triglyceride levels are also reduced."

Target numbers Your triglycerides, along with your LDL and HDL, are measured by a blood test called a "lipid panel" or "lipid profile," which is customarily included in testing your doctor orders at your annual routine exam. Most experts recommend keeping fasting triglyceride levels (the level after you have fasted overnight) below 200 milligrams per deciliter (mg/dL), but in some cases, 150 mg/dL or less may be preferable. A triglyceride level between 200 and 499 mg/dL is considered high, and 500 mg/dL or above is considered very high. Although it is rare, some peoples triglycerides get above 1,000 mg/dL, which raises the risk for pancreatitis. "Pancreatitis occurs when the pancreas becomes inflamed," Dr. Darrow explains. "This interferes with the normal release of hormones and digestive enzymes, and chronic pancreatitis can result in bleeding, infection, and permanent tissue damage."

Tackling triglycerides If your triglycerides are high, changes in your diet and exercise habits can help. "For most people, lifestyle changes can have a bigger effect on triglycerides than medications," says Dr. Darrow. Eat a healthful diet high in fruits and vegetables, whole grains, and fatty fish (tuna, salmon, sardines, mackerel). Avoid beverages that are high in fructose--this includes sodas sweetened with fructose, as well as fruit juices (even those that don't contain any added sweeteners). Dr. Darrow also advises restricting your alcohol intake to no more than one drink per day, since alcohol intake can raise triglycerides.

If you are overweight or obese, losing even five to 10 percent of your body weight will help. "Losing weight will reduce your intra-abdominal fat, and your triglycerides will come down," says Dr. Darrow. For a better chance at shifting extra pounds, combine healthful eating with exercise. "A regimen of 30 minutes per day of moderate-intensity activity five or more days per week is ideal," Dr. Darrow suggests, "and remember that activities such as housework, yard work, and gardening count as physical activity."

Medication options Many patients with very high triglyceride levels have one or more genes that cause increased triglyceride production, regardless of their diet. For those individuals, as well as those whose triglycerides don't fall sufficiently with lifestyle changes, medications can help.

Medications that have the most powerful effect on triglycerides include fibric acids such as gemfibrozil and fenofibrate. Niacin (the prescription form is called Nias pan[R]) also can be very effective, but can cause side effects such as noticeable flushing of the skin. The flushing does tend to ease over time, as your system becomes accustomed to the medication, but a time-release version of the drug may be less likely to cause this problem. "Another alternative is to take the niacin at night so you won't be so aware of the flushing," Dr. Darrow adds, "or, if you are taking aspirin as well, to take it after you take aspirin, which helps counteract the flushing."

Statin drugs such as rosuvastatin (Crestor[R]) and atorvastatin (Lipitor[R]), which are more commonly used to lower LDL levels, are another option. Fish oils can help, but like niacin, they must be taken in fairly high doses.


* Eat fruit instead of drinking fruit juices This will decrease your fructose intake and boost fiber and other nutrients.

* If 30 minutes of exercise sounds overwhelming, break up activities like walking and bicycling into 10- or 15-minute increments, and do them two or three times a day.

* If you drink alcohol, avoid mixers that contain sugar, and choose dry rather than sweet wines.

* Ask your doctor about appropriate dosages before you take over-the-counter niacin and/or fish oil.
Fasting triglyceride
with HDL and
LDL levels--are
measured by blood
tests your doctor
will likely order at
your routine annual
physical. A level
of 200 mg/dL is
considered normal,
though the target
may be lower for
some individuals.

VERY HIGH     500mg/dL or higher
HIGH           200-400 mg/dL
NORMAL         200 mg/dL or less
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Publication:Focus on Healthy Aging
Date:Feb 1, 2016
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