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Doctors' Answers to "Frequently Asked Questions" - Tryglycerides

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/27/2000]
Question: What are triglicerides ?

Answer: A type of fat produced by your body, a mild risk factor for coronary artery disease. Best checked after a 12 hour fast-very diet sensitive compared to cholesterol levels.

[posted 07/21/2000]
Question: While pregnant and post pregnancy[7 yrs ago],I developed pancreatitis due to high tryglycerides.I had my gallbladder removed and parts of my pancreas due to this.My counts were 6000 and 8000 respectively.Right now they are at 1700.I am on tricor and was wondering if this is a good med. for my condition?I also had gestational diabetes at the time.Also,could this be a sign of me being diabetic?

Answer: Triclor would be fine to lower your triglycerides. The risk of diabetes after pancreatitis is fairly high and should be watched periodically. But, does not mean you are currently diabetic.

[posted 02/26/2000]
Question: My Tri's are almost 1,300. I was taking Lipitor for cholesterol and now they have stopped my taking it and started me on lopid. I believe it is a family problem, my father was thin and had high cholestrol and tri's too. Please can you tell me what I should do to help bring them down. Also what can I eat. My insurance will not send me to a nutricianist. I need help I am only 32 years old. I work physically. HELP Please. Thanks a million

Answer: Lopid or Triclor would be the best medications. The diet is mainly to lose weight. Put emphasis on low fat. In general, the lopid fixes most of the problem, but losing weight is the key.

[posted 11/5/1999]
Question: My family doctor decided during my visit earlier this week to do some blood work, and I was called back today saying that my triglycerides were 532, and should be no higher than 250. I was not required to fast prior to the app't. or the blood being drawn, so am a bit confused as to how reliable these results are in the first place. Aside from that, however, I am also wondering if any of the prescription medications I am on might have any impact on the level of triglycerides in my system. Furthermore, what is the best plan of action for a person to go about getting their triglyceride levels back under control? I am not sure I understand exactly which foods to avoid or which ones might be helpful, and what level of exercise would be sufficient, etc. My cholesterol was at 213. I am 6 feet tall (female), and weigh more than I should at 190 pounds. I do not have a large bone frame, so should actually not weigh much more than about 145-150. I have two young children, if that factors in whatsoever. If there are any other details which might help you in answering me, please feel free to let me know. I appreciate your time and effort in helping me to gain some understanding of this so I can take a little better care of myself. My family physician has indicated that she wishes to retest my triglyceride levels in 3 mos. after I "watch my diet" (all she said to specifically watch were saturated fats - ??), and if the levels are not down to where she would like to see them by that time, she mentioned putting me on some type of medication, but didn't say what. Thanks again for your input!

Answer: First of all, start looking for a different physician. Triglycerides are the most diet sensitive of the lipid monitors. They are very sensitive to diet and alcohol intake. You need to be off alcohol for three days and fasting for twelve hours to get an accurate assesment. There has been a huge debate raging for years about the importance of triglycerides and the need to treat them. Within the last year, the Harvard Public Health Group using the Framingham Information Base published a good study showing that elevated triglycerides does increase the risk of stroke/heart attack as an independent risk factor. This has taken over thirty years of study to document, so it isn't a strong risk factor-if it is at all. What has not been shown is that treating triglycerides affects strokes/heart attacks. This will take a long time, if it is even able to be done considering the low risk that is documented. Most physicians would like to lower triglycerides and some would treat them independently. Most think that they are elevated as a marked of another problem. This seems to be related to how your body metabolizes insulin and this may be an early marker for developing diabetes mellitus down the road. This is also unclear. We always treat levels above 1000 because there is a risk of pancreatitis with high levels, but this is not your problem. The treatment is to lose weight. It doesn't seem to matter about the calorie make up and balance between protein/carbs/fats as long as you lose. Exercise may also help a lot, reinforcing the insulin theory. So, recheck them now to see if there is any concern and start losing weight. I would treat this or not based on your family risk profile and other risk factors rather than the triglycerides themselves. That is, if you have relatives before 65(some would use 55) with strokes/heart attacks or hypertension/diabetes/smoking/obesity to treat them. This varies extensively between physicans -meaning that we really don't know what to do with triglycerides.

Triglycerides [posted 7/17/98]
Question: A co-worker and friend had by-pass surgery last year. He is using Lipitor, Accupril, and Trovan. The Trovan For the last 4 weeks. At his last check up his LDL's shot from 200 something to over 700 and something. Is the new drug Trovan driving his triglycerides up?

Answer: I am not familiar with Trovan. Do you have a generic name? In any case, the only way to know is to stop it and see what happens to triglycerides post Trovan. Itís certainly suspicious.

Question: Having been tested at 3400 for triglycerides, my physician put me on lopid over two years ago. With the lopid and a somewhat restricted diet, I now range in the 800-1200 range. My question is two fold. Is the lopid doing any damage to my liver? And would the addition of lipitor be of any benefit. All testing is done with a minimum 12 hour fast. They keep telling me that they can't read my cholesterol because of the high triglycerides. So I don't have a clue as to the good or bad types. Also, has there ever been any connection found between high triglycerides and impotence? Everything seems to work much better when I watch my diet and get the triglycerides down below say 900. Is that just in my head or is there anything to it?

Answer: Both lopid and lipitor will lower triglycerides, you'd have to see which one has the greater effect. I'm not aware of head on head studies. Both medications can have liver toxicity, but monitoring will reduce this risk (which is fairly low to begin with). Long term use necessitates occasional liver tests. As to the impotence, itís hard to say, although there certainly could be a connection. This isn't a common complaint though.

Question: I am a 34 year old man living in Kuwait. I am very thin and about 55 KG. Recently, I had a full blood test and everything was normal except Triglycerides. I have high Triglycerides in my blood, although I do not eat much fatty food. Where did I get the Triglycerides? The reports reads as : Triglycerides 3.78 MMOL/L where 0.0 - 1.8 is the expected value. I don't know what to eat and what to not as I already do not eat a lot of fatty food. I would appreciate if you could advise me to keep the Triglycerides either reduced or controlled.

Answer: First, was the sample fasting? Triglycerides are very sensitive to calorie intake and will rise rapidly after eating. A 12 hour fast is necessary for accurate testing. Having said this, I wouldn't worry too much about this. Triglycerides are a minimal risk factor for coronary disease and some would say not a risk factor at all. They are a risk factor to eventually develop diabetes mellitus and I'd check your sugar every other year or so. Keep your weight down and don't worry if the cholesterol is OK.

Question: What are the major contributing factors to a high level of triglyceride?

Answer: It seems to be fairly genetic and seems to pertain to the levels of insulin in your body and how your body uses insulin. However, high triglyceride levels are only a minor risk factor for coronary disease. Some authors cite that they are unrelated. They are related to the eventual development of diabetes mellitus and DM is a risk factor for heart disease. Very high levels will increase the risk of pancreatitis(usually over 10,000 or so). Weight loss and exercise are the best treatment options. Focus more on your cholesterol and start exercising to head off any risk of diabetes mellitus.

Triglycerides / Premarin
Question: I have been on premarin for a year now and I am 53. My cholesterol and triglycerides increased substantially. I was put on zocor and I feel I have familiar hypertriglyceremia. I am wondering if it is safe to take premarin or if there is an alternative medication that is available? Also, my blood pressure occasionally rises in times of stress. I exercise for 30 minutes every day.

Answer: While it is true that some patients do have an elevation of triglycerides with estrogen this is not thought to increase risk of strokes and heart attacks. This is because elevated triglycerides by themselves have a very low to non-existent risk for heart disease. Triglycerides do increase the risk of Diabetes Mellitus and Diabetes does have a risk for heart disease. Incidentally, there only one drug that substantially decreases the risk for coronary disease and that is estrogen. Blood pressure needs to be watched with estrogen, but in general the overall risk of coronary disease with estrogen is about 10-15% as without it.

Question: Do you have any information on combination cholesterol lowering agents for use in a patient presently on Mevacor with a Cholesterol level of 238, but a Triglcerides level of 920. Are there any better choices?

Answer: A recent addition is Lipitor which is the first HMG, Co A to be approved for lowering triglycerides. I'd try this first. If the triglycerides are still too high, addition of niacin or lopid can be tried. However, they tend to have additive liver toxicity and must be watched very closely.

Question: What are triglycrides? How do they enter the body, and in what foods? What is the best way to lower their levels? My triglyceride level is 320 and my cholesterol is at 173. Where can I obtain additional information on them? How much is really know about their effect?

Answer: Triglycerides are manufactured by your body in the liver. They are also absorbed with almost any ingested fat as long chain triglycerides. Consequently, a low fat, high fiber diet will reduce the amount entering your body. There is much medical debate concerning triglycerides. Finding a direct correlation between high levels and vascular disease has been difficult. Extremely high levels (5000 or higher) can cause pancreatitis. There is also a good correlation between a high triglyceride level and the eventual development of diabetes mellitus (a known cause of vascular disease). Three hundred is not especially high, but can be reduced by weight loss and a low fat diet. There are lipid lowering agents, especially niacin, lopid and the newer lipitor which lower triglycerides. I would focus more on cholesterol. Also, this is one test that is very influenced by food. Accurate levels can only be obtained after a 10 to 12 hour fast.

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