Very High Triglycerides

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1 Understanding Very High Triglycerides For more information, visit CardioSmart.org/VHTG

2 Understanding Very High Triglycerides Keeping track of your cholesterol is a very good idea. That s also true for your blood pressure, blood sugar levels, and waistline. You ve probably heard about LDL ( bad ) cholesterol and HDL ( good ) cholesterol. But are you aware of the importance of your triglyceride levels to your overall health? Triglycerides are one of the four numbers you see on the standard blood test your doctor gives you to check for cholesterol in your bloodstream. When that triglyceride number is very high, it can translate into real trouble for your heart and lead to other health issues, as well. Blood Vessel Blood Cell Fat Cells Triglycerides are a type of fat that s used as an energy source for your body. Too much of this type of fat can clog your arteries and increase your risk for heart attack or stroke.

3 CardioSmart.org/VHTG What are triglycerides? Triglycerides are one type of fat (lipid) found in your bloodstream. Your liver makes triglycerides, and you also get them through many of the foods you eat. In fact, your body converts any extra calories after you eat right away into triglycerides. Your fat cells store these fatty substances. They are later released and circulate the bloodstream to be used as energy by cells. But as with LDL cholesterol, too much can be harmful. Most dietary fats are triglycerides. What are very high triglycerides? Having very high triglycerides (VHTG) means that you have too much of this type of fat in your blood. Your doctor may call this condition severe hypertriglyceridemia. This condition is detected through a simple blood test called a lipid panel or lipid profile. This test measures your: Overall cholesterol LDL cholesterol HDL cholesterol Triglycerides You will likely be asked to get your blood taken after fasting when you haven t had any food or drink (except water) for at least eight hours. That s because the food you recently ate can change your triglyceride level. Because so many of your triglycerides come from the food you eat, triglycerides are usually lowest after fasting and highest after eating. So eating a heavy meal can actually cause a spike in the amount of triglycerides in the blood. Like other types of cholesterol, triglycerides are measured in milligrams per deciliter (mg/dl) of blood.

4 Understanding Very High Triglycerides There are four categories of triglyceride levels, according to the American Heart Association. Someone is diagnosed with very high triglycerides when the amount of triglycerides found in the blood is 500 mg/dl or more; under 150 mg/dl is considered normal. Classification Healthy Borderline high High Very high What causes VHTG? Triglyceride Level (mg/dl) Less than 150 mg/dl 150 to 199 mg/dl 200 to 499 mg/dl 500 mg/dl or higher A number of factors can raise triglycerides, or cause very high triglycerides. For example, it tends to be more common in people with: Low thyroid levels (hypothyroid) Poorly controlled diabetes Kidney disease A genetic predisposition where the body produces an excess amount of triglycerides Other things that can raise triglyceride levels include: Certain medicines, including some birth control pills, beta blockers, antipsychotics, and corticosteroids A diet that is high in carbohydrates, or processed or sugary foods Alcohol Not exercising Are certain people more likely to develop it? Yes. As mentioned, some people have a genetic deficiency or family history that makes them more prone to very high triglycerides. The condition is also more common in: People who are very overweight or obese Women, especially those who are pregnant, are taking estrogen or hormone replacement therapy,

5 CardioSmart.org/VHTG or have polycystic ovary syndrome People who develop heart disease before age 50 Mexican-American men Indian Americans Being Overweight Age Being Inactive Family History Poor Diet Are there signs and symptoms? There usually aren t any symptoms. However, people with very high triglycerides can develop coronary disease at an early age. Because there aren t any overt symptoms, routine blood testing to check your blood cholesterol levels may be the best idea. Why is VHTG dangerous? Having very high triglycerides, no matter the cause, has been linked to a higher chance of developing heart disease and having a heart attack or stroke. While research is still underway to find the exact relationship between triglycerides and cardiovascular disease, we know that very high triglyceride levels tend to cluster with other risk factors, including being obese, high blood pressure, and high cholesterol. Research shows that very high triglycerides often occur along with: Lower levels of good or HDL cholesterol, which help clear cholesterol from the bloodstream Smaller particles of the bad cholesterol, which can speed up atherosclerosis

6 Understanding Very High Triglycerides Changes to the body s ability to break down blood clots, which can increase the risk of stroke Metabolic syndrome Taken together, these factors can set the stage for serious cardiovascular problems. There s another potential problem. Extremely high levels of triglycerides can also lead to pancreatitis, a very serious condition in which the pancreas becomes inflamed. Pancreatitis can cause significant pain and usually results in hospitalization. What is the usual treatment for VHTG? Research into whether lowering triglycerides can measurably reduce the risk of heart disease or events is still ongoing. Still, most experts say it s best to keep them within the normal range. The goal of any treatment program is to: 1. Lower the amount of triglycerides in the blood 2. Control conditions that can raise triglyceride levels (for example, obesity, diabetes, hypothyroidism, kidney disease)

7 CardioSmart.org/VHTG Increase physical activity Adopt a healthy diet Lose weight Taking prescription medication may be required in some patients for whom lifestyle changes are not enough. Current standards of care include statins, fibrates, omega-3s and niacin The best way to lower triglycerides is by making healthy lifestyle choices. Just doing this can cut triglyceride levels by half! That means you have some control over reducing triglycerides. Talk with your doctor about making healthier lifestyle choices by taking these 4 steps: 1. Be more active regular exercise can lower triglycerides and raise good cholesterol. 2. Improve your diet that means trying to: Cut out excess calories by limiting unhealthy fats; dietary fat should only make up percent of your total diet Eat fiber-rich carbohydrates such as vegetables

8 Understanding Very High Triglycerides and whole grains, and limit simple carbohydrates (white breads, pasta, potatoes) Limit alcohol, which can cause triglycerides to spike in some people Eat foods rich in omega-3 fatty acids, available in certain fish (salmon, tuna, lake trout, and sardines), fish oil or flaxseed oil Avoid refined sugars 3. Lose weight and stay at a healthy body weight losing just 5-10 percent of your weight can lower triglycerides. 4. Don t smoke. Lifestyle modifications seem to work well and, in some cases, are as effective as taking medicine for lowering triglycerides. Taking the above steps will help you improve your overall health, too. In some cases, your doctor may also prescribe medications to lower your triglycerides. These might include: Omega-3 fatty acids: Prescription forms of highdose omega-3 fatty acids (which are naturally found in fish) can lower triglycerides, but researchers don t know exactly how yet. There are several FDA-approved omega-3 fatty acid formulations for VHTG; most include both EPA and DHA as active ingredients. These tend to be well tolerated and have been shown to reduce triglycerides by as much as 50 percent. Fibrates: These medications work by impairing the liver s ability to release triglycerides. Niacin or vitamin B3: These work by reducing the activity of a chemical needed for the body to produce triglycerides. Statins: These are commonly used to lower LDL cholesterol and may also lower triglycerides.

9 CardioSmart.org/VHTG As always, when taking medications: Take them exactly as directed. Let your health care team know about all of the other medicines you take. Report any side effects or concerns. Medication Omega-3 fatty acids Niacin Fibrates Statins Important Considerations/ Side Effects Only FDA-approved, prescription strength omega-3 fatty acids should be used to treat VHTG. While there are dietary supplements (commonly referred to as off-the-shelf ), these are not the same. People who have an allergy to fish or shellfish should not take omega-3 fatty acids. If you take the EPA and DHA combination, you may need to get your LDL cholesterol checked because DHA seems to raise this in some people. Swallow the liquid gel capsule whole and do not take it with a hot beverage. Tell your doctor if you notice any bruising. Immediate-release formulations of this drug that work quickly in the body can sometimes result in flushing, itching, stomach upsets, and raised blood sugar. Dosages need to be adjusted for people with kidney problems. You should not take fibrates if you have liver and/or gallbladder disease. Taking statins and fibrates at the same time can make serious muscle problems more likely. This can lead to kidney failure. Minimal, if any, positive effect on triglycerides, as research findings are mixed. Tell your doctor if you also take fibrates. *This table does not address all concerns or special considerations. Talk with your doctor about the pros and cons of all medications.

10 Understanding Very High Triglycerides There are many new treatments for very high triglycerides being investigated, as well. As always, talk with your doctor about the right approach for you. Questions to ask It s always a good idea to be prepared to ask questions about any condition you have. The more you know, the more you can take proactive steps to take care of yourself. On the next page are a few questions to help get you started.

11 CardioSmart.org/VHTG Questions you might ask include: How are triglycerides different from cholesterol? What is my triglyceride level? How often should this and my other cholesterol levels be checked? Why do you think my triglyceride level is so high? How can high triglycerides affect my heart health? What is the best thing I can do to lower triglycerides? What changes can I make to my diet that will help? Do sugars cause high triglycerides? How can I better control other risk factors for heart disease? How is the prescription form of omega-3 fatty acids different from what I can get in the grocery store or pharmacy?

12 Helpful resources To learn more about triglycerides, visit CardioSmart.org/VHTG You can also find resources at: National Heart, Lung, and Blood Institute nhlbi.nih.gov For more information, visit CardioSmart.org/VHTG Information provided for educational purposes only. Please consult your health care provider regarding your specific health needs. Dissemination of this brochure was made possible by a grant from Amarin Pharma, Inc. Amarin was not involved in the development of this material and in no way influenced it contents. 2016, American College of Cardiology

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