Health Library High TriglyceridesFrom Healthwise

What are triglycerides?

Triglycerides are a type of fat found in your blood. They are a major source of energy and the most common type of fat in your body.

When you eat, your body uses the calories it needs for quick energy. Any extra calories are turned into triglycerides and stored in fat cells to be used later. The excess calories are stored as fat regardless of what kind of food you eat—fat, carbohydrate, or protein. If you regularly eat more calories than you burn, you may have high triglycerides.

In normal amounts, triglycerides are important to good health. When triglyceride levels are high, it is not clear whether these high levels directly increase your risk for heart disease. But high triglycerides are often part of a group of conditions called metabolic syndrome.

Metabolic syndrome is the combination of high blood pressure, high blood sugar, too much fat around the waist, low HDL ("good") cholesterol, and high triglycerides. This syndrome does increase your risk for heart disease as well as for diabetes and stroke.

Triglycerides are measured as part of a blood test that measures your cholesterol. Normal triglyceride levels are below 150. High levels are 200 or above.

What causes high triglycerides?

Conditions that may cause high triglycerides include:

• Obesity.
• Poorly controlled diabetes.
• An underactive thyroid (hypothyroidism).
• Kidney disease.
• Regularly eating more calories than you burn.
• Drinking a lot of alcohol.

Certain medicines may also raise triglycerides. These medicines include:

• Tamoxifen.
• Steroids.
• Beta-blockers.
• Diuretics.
• Estrogen.
• Birth control pills.

Certain types of high cholesterol and high triglycerides are caused by genetics.

What are the symptoms?

High triglycerides usually do not cause symptoms.

Sometimes high triglycerides have a genetic cause. But this is not common. In this case, high triglyceride levels may occur along with visible fatty deposits under the skin called xanthomas.

In rare cases, people who have very high levels of triglycerides may develop inflammation of the pancreas ( pancreatitis). This can cause sudden, severe abdominal pain, loss of appetite, nausea, vomiting, and fever.

How can you lower your high triglycerides?

If you are overweight, losing weight may be the best way to lower triglycerides. You may be able to lower your triglycerides by eating fewer calories and increasing your activity. Other diet changes that might help include limiting fats and sugars, and limiting or not drinking alcohol.

If increasing your activity and watching calories do not work, you may also need medicine. Medicines called statins are commonly used to lower LDL ("bad") cholesterol. But drugs called nicotinic acid (or niacin) and fibrates seem to work better for lowering triglycerides. If you have high triglycerides, high LDL cholesterol, and low HDL ("good") cholesterol, you may take more than one type of medicine that lowers cholesterol.

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The most common causes of high triglycerides are obesity and poorly controlled diabetes. If you are overweight and are not active, you may have high triglycerides, especially if you eat a lot of carbohydrate or sugary foods or drink a lot of alcohol. Binge drinking (of alcohol) can cause dangerous spikes in triglyceride levels that can trigger inflammation of the pancreas ( pancreatitis).

Other causes of high triglycerides include hypothyroidism, kidney disease, and certain inherited lipid disorders.

Estrogen replacement therapy, which may be used for menopause symptoms, may also raise triglyceride levels. Certain medicines may also raise triglycerides. These medicines include:

• Tamoxifen.
• Steroids.
• Beta-blockers.
• Diuretics.
• Birth control pills.

High triglycerides rarely occur on their own. They are usually associated with other conditions.

High triglycerides are a part of metabolic syndrome, a group of medical problems that increase your risk of heart attack, stroke, and diabetes. Metabolic syndrome includes:

• High triglycerides.
• Low HDL ("good") cholesterol.
• High blood pressure.
• High blood sugar.
• Too much fat, especially around the waist.

High triglycerides by themselves do not cause symptoms. If your high triglycerides are caused by a genetic condition, you may have visible fatty deposits under the skin called xanthomas.

In rare cases, people who have very high triglyceride levels may develop inflammation of the pancreas ( pancreatitis), which can cause sudden, severe abdominal pain, loss of appetite, nausea and vomiting, and fever.

Triglycerides are categorized as follows:

If you have high triglycerides, you may also have high cholesterol. In many cases, people don't know that they have high triglycerides until they have a blood test called a lipoprotein analysis to check their cholesterol levels.

If your triglyceride levels are high, your doctor will also check for and treat other associated conditions that may be linked to high triglycerides. These conditions include diabetes, hypothyroidism, kidney disease, and metabolic syndrome.

You can use diet and lifestyle changes to lower triglyceride levels. These changes may be especially good at lowering borderline-high levels (150 to 199 mg/dL) back to normal levels (less than 150 mg/dL).

Diet and lifestyle changes include:

• Staying at a healthy weight.
• Limiting fat and sugars.
• Being more active.
• Limiting alcohol.

You may also take medicines to lower triglyceride levels. Medicines may be used if you have risk factors for coronary artery disease (CAD). In this case, your doctor may first want to lower your LDL ("bad") cholesterol level and raise your HDL ("good") cholesterol level before adding medicine to lower your triglycerides.

Treating LDL and HDL can lower your risk of heart attack and death, but the risks of high triglycerides are not as well known. For more information on target levels and treatment for high cholesterol, see the topic High Cholesterol.

Use this Interactive Tool: Heart attack risk to calculate your risk of a heart attack based on your cholesterol levels and other factors.

Initial treatment

Diet and lifestyle changes are the first steps you will take to lower triglyceride levels.

Diet and lifestyle changes include:

• Staying at a healthy weight or reducing calories to lose weight.
• Limiting the amount of carbohydrate and unhealthy fat that you eat.
• Being more active.
• Limiting alcohol.
• Not smoking.
• Keeping blood sugar as close to normal as possible if you have diabetes.

Adding fish oils (omega-3 fatty acids) to your diet may lower triglyceride levels.¹ You can add fish oil by eating fish at least 2 times a week or by taking supplements. Oily fish with lots of omega-3 fatty acids include salmon, tuna, and mackerel.

You may want to try Therapeutic Lifestyle Changes (TLC) and the Therapeutic Lifestyle Changes (TLC) diet. TLC is a combination of diet and lifestyle changes that can lower your cholesterol. The following information can help you get started with the TLC diet:

• Therapeutic Lifestyle Changes (TLC) diet
• Sample menu for the TLC diet
• Tips for success with the Therapeutic Lifestyle Changes (TLC) diet

To reduce carbohydrate in your diet, you may want to learn about the amount of carbohydrate in various foods.

Alcohol has a particularly strong effect on triglycerides. Regular, excessive use of alcohol or even a one-time drinking binge can cause a significant increase in triglycerides. Binge drinking can cause a spike in your triglycerides that may trigger pancreatitis. Your doctor will want you either to stop or to limit the amount of alcohol you drink.

Before you increase your activity, check with your doctor to be sure it is safe. You may also want to talk with a dietitian to design a nutrition program that is right for you.

Your doctor will also look for anything else that might be causing your high triglycerides, such as hypothyroidism, poorly controlled diabetes, kidney disease, or medicines. Your doctor may adjust or stop any medicines that might raise your triglyceride level.

Ongoing treatment

If your triglycerides are still high after you make lifestyle changes, you may need to take medicine as well. Whether your doctor prescribes medicine for high triglycerides depends on more than just your triglyceride number. Your doctor will also look at your cholesterol levels and other risk factors for heart disease before prescribing a medicine for high triglycerides.

If you have high cholesterol and other risk factors for heart disease, you may need a combination of medicines that target the different types of cholesterol. The medicines that you might take are:

• Statins.
• Fibrates.
• Nicotinic acid.

Statins are used to lower LDL (bad) cholesterol. Statins may also lower triglycerides and even raise HDL (good) cholesterol. Typically, the more a statin lowers LDL, the more the drug lowers triglycerides. When your LDL is at a desirable level, fibrates or nicotinic acid may be added to target triglycerides. Both of these medicines can also raise your HDL cholesterol.

If your triglycerides are very high, your doctor may first use medicine to lower your triglycerides to prevent damage to your pancreas.

Fibrates (fibric acid derivatives) should be used with caution by people who are also taking statins. There is a greater risk of developing a life-threatening muscle problem called rhabdomyolysis, which can lead to kidney failure. So it is important that your kidneys and liver are healthy before you take this combination of medicines. If you have any muscle problems or pain, report it immediately to your doctor.

Treatment if the condition gets worse

If you have not previously been taking medicines for high triglycerides, you probably will start. If you have been taking medicines, but they have not been effective, your doctor may change your dosage or add new medicines. The medicines that you might take are:

• Statins.
• Fibrates.
• Nicotinic acid.
• Omega-3 fatty acids (fish oil).

If you are taking a statin, you need to be extra careful if you are also taking fibrate medicines. There is a greater risk of developing a life-threatening muscle problem called rhabdomyolysis, which can lead to kidney failure. Before you can take this combination of medicines, your kidneys and liver must be healthy and function normally. If you have any muscle problems or pain, report it immediately to your doctor.

Your doctor may prescribe an omega-3 fatty acids medicine (such as Lovaza). You can get omega-3 fatty acids from eating oily fish like salmon or tuna. But this medicine is a highly concentrated form of omega-3 fatty acids, which can lower triglyceride levels. This medicine is used in combination with diet and lifestyle changes for high triglycerides. This medicine may raise LDL cholesterol levels slightly, so your doctor may closely watch your cholesterol levels if you take Lovaza.

You may need to think about how well you are able to follow your plan for making lifestyle changes. You may need to get some help to meet your goals. Consider meeting with a registered dietitian or nutritionist who can work with you to make healthier food choices. Do not overlook the importance of increasing your activity—join a health club or consult a personal trainer who can design a program for you to help make exercising interesting, fun, and more effective. You may want to choose walking to help increase activity in your life.

Fitness: Walking for wellness

Diet and lifestyle changes that can help lower your triglycerides. For example:

• Stay at a healthy weight. Triglycerides are stored as fat in your tissues and muscles.
• Eat fewer calories. Excess calories are converted to triglycerides.
• Eat a heart-healthy diet. Limit high-calorie foods and carbohydrate, especially high-sugar foods such as cookies, soda, and fruit juices.
• Limit unhealthy fats in your diet, especially saturated fat. Choose a diet like the Therapeutic Lifestyle Changes (TLC) diet. For more information, see:
  • Therapeutic Lifestyle Changes (TLC) diet.
  • Sample menu for the TLC diet.
  • Tips for success with the Therapeutic Lifestyle Changes (TLC) diet.
• Limit alcohol, which has a strong effect on triglycerides.
• Be more active. Get at least 30 minutes of activity on most, preferably all, days of the week. Walking is one way to add activity to your daily life. For more information, see:

  Fitness: Walking for wellness.

• Stop smoking. See the topic Quitting Smoking for information on how to quit.

Organizations

• High Cholesterol
• Obesity
• Type 2 Diabetes

Citations

1. Gaziano JM, et al., (2004). Primary and secondary prevention of coronary heart disease. In E Braunwald et al., eds., Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., pp. 1057–1084. Philadelphia: Saunders.

Other Works Consulted

• American Heart Association (2006). Diet and lifestyle recommendations revision 2006. Circulation, 114(1): 82–96. [Erratum in Circulation, 114(1): e27.]

Author:	Robin Parks, MS	Last Updated: July 12, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology
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