Triglycerides: Why do they matter?

If you've been keeping an eye on your blood pressure and cholesterol levels, there's something else you might need to monitor: your triglycerides.

Having a high level of triglycerides in your blood can increase your risk of heart disease. But the same healthy choices that promote overall health can help lower your triglycerides too.

Triglycerides are a type of fat, also known as a lipid, found in your blood.

When you eat, your body converts any calories it doesn't need to use right away into triglycerides. The triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals.

If you regularly eat more calories than you burn, particularly from high-carbohydrate foods, you may have high triglycerides. This condition is called hypertriglyceridemia.

A simple blood test can reveal whether your triglycerides fall into a healthy range:

• Healthy — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L).
• Borderline high — 150 to 199 mg/dL (1.7 to 2.2 mmol/L).
• High — 200 to 499 mg/dL (2.3 to 5.6 mmol).
• Very high — 500 mg/dL or above (5.7 mmol/L or above).

A healthcare professional typically checks for high triglycerides as part of a cholesterol test, which is sometimes called a lipid panel or lipid profile. You have to fast before blood can be drawn for an accurate triglyceride measurement.

Triglycerides and cholesterol are different types of lipids that circulate in your blood:

• Triglycerides store unused calories and provide your body with energy.
• Cholesterol is used to build cells and certain hormones.

High triglycerides may contribute to hardening of the arteries or thickening of the artery walls, called arteriosclerosis. This condition increases the risk of stroke, heart attack and heart disease. Extremely high triglycerides also can cause acute inflammation of the pancreas, called pancreatitis.

High triglycerides are often a sign of other conditions that increase the risk of heart disease and stroke, including obesity and metabolic syndrome. Metabolic syndrome is a cluster of conditions that includes too much fat around the waist, high blood pressure, high triglycerides, high blood sugar and low good cholesterol levels. Metabolic syndrome increases the risk of heart disease and stroke.

High triglycerides also can be a sign of:

• Type 2 diabetes or prediabetes.
• Low levels of thyroid hormones, called hypothyroidism.
• Certain rare genetic conditions that affect how your body converts fat to energy.

Sometimes high triglycerides are a side effect of taking certain medicines, such as:

• Diuretics.
• Estrogen and progestin.
• Retinoids.
• Steroids.
• Beta blockers.
• Some immunosuppressants.
• Some HIV medicines.

Healthy lifestyle choices are key:

• Exercise regularly. Aim for at least 30 minutes of physical activity on most or all days of the week. Regular exercise can lower triglycerides and boost high-density lipoprotein (HDL), also called the "good" cholesterol. Try to incorporate more physical activity into your daily tasks — for example, climb the stairs at work or take a walk during breaks.
• Avoid sugar and refined carbohydrates. Simple carbohydrates, such as sugar and foods made with white flour or fructose, can increase triglycerides.
• Lose weight. If you have mild to moderate hypertriglyceridemia, focus on cutting calories. Extra calories are converted to triglycerides and stored as fat. Reducing your calories can reduce triglycerides.
• Choose healthier fats. Trade saturated fat found in meats for healthier fat found in plants, such as avocado, nuts, and olive and canola oils. Instead of red meat, try fish high in omega-3 fatty acids — such as mackerel or salmon. Avoid trans fats or foods with hydrogenated oils or fats.
• Limit how much alcohol you drink. Alcohol is high in calories and sugar and has a particularly potent effect on triglycerides. If you have severe hypertriglyceridemia, avoid drinking any alcohol.

If healthy lifestyle changes aren't enough to control high triglycerides, your healthcare professional may recommend:

• Statins. These cholesterol-lowering medicines may be recommended if you also have unhealthy cholesterol numbers or a history of blocked arteries or diabetes. Examples of statins include atorvastatin calcium (Lipitor) and rosuvastatin calcium (Crestor).
• Fibrates. Fibrate medicines, such as fenofibrate (Antara, Lipofen) and gemfibrozil (Lopid), can lower your triglyceride levels. Fibrates aren't used if you have severe kidney or liver disease. Their main role is to lower low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — but they also may lower triglycerides.
• Fish oil. Also known as omega-3 fatty acids, fish oil can help lower your triglycerides. Prescription fish oil preparations, such as Lovaza, contain more-active fatty acids than many supplements you can buy without a prescription. Supplements you can buy over the counter may not be effective. Fish oil taken at high levels can interfere with blood clotting, so talk to your healthcare professional before taking any supplements.
• Niacin. Niacin, sometimes called nicotinic acid, can lower your triglycerides and LDL cholesterol. Talk to your healthcare professional before taking niacin you can buy without a prescription because it can interact with other medicines and cause serious side effects.

If your healthcare professional prescribes medicine to lower your triglycerides, take the medicine as prescribed. And remember the power of the healthy changes you've made to lower triglycerides. Medicines can help — but healthy choices matter, too.

For most people, health changes and medicine can bring triglyceride levels down. But a small number of people have very high triglyceride levels that resist treatment. This may be caused by a genetic condition. These people may be at higher risk of serious complications such as pancreatitis, and they may not respond well to standard therapies.

If your triglyceride levels stay very high even after treatment, or if you have a family history of high triglycerides or early heart disease, your healthcare professional may refer you to a specialized lipid clinic. These clinics focus on diagnosing and managing rare or complex lipid conditions.

If you've struggled to lower your triglycerides, ask your healthcare professional if seeing a lipid specialist is right for you.