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Doctors' Answers to "Frequently Asked Questions" - Tryglycerides
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.
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.
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.
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]
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.
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.
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.
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
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.
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.
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.