Discussions about heart health often center around blood pressure and cholesterol, with factors like poor sleep, smoking, family history of heart disease, and chronic stress thrown in. However, there’s one variable that doesn’t get covered as often, even though it can be an important indicator of cardiovascular risk: triglycerides.

“We don’t really talk about triglycerides very much, especially compared to cholesterol, but they’re actually an essential part of understanding heart health,” says Dr. Adriana Quinones-Camacho, a cardiologist at NYU Langone Health in New York. “For someone with a condition that raises their heart risks, such as diabetes, knowing if triglycerides are elevated can be a critical part of maintaining their health overall.”

Whether you have diabetes or another potentially chronic medical issue, or are simply looking for a way to track any changes in your health status, it’s worth taking a deeper dive into what triglycerides are—and what can happen when you have too many.

What are triglycerides?

Triglycerides are a type of fat (or lipid) naturally made in your liver; when you eat, its production increases. Excess calories are converted into triglycerides and stored in fat cells in the bloodstream, so they can be used for energy boosts and temperature regulation when needed.

This process differs from another well-known lipid, cholesterol—which builds cells and plays a part in making hormones. Both triglycerides and cholesterol are essential for keeping your body functioning properly. For instance, without enough triglycerides, you’d likely struggle with fatigue, feeling cold, dry skin, and even potential malnutrition since lipids are necessary for absorbing some types of nutrients.

Triglyceride readings are sorted into four categories: normal, borderline high, high, and severe. A normal reading is less than 150 milligrams per deciliter (in a lab report, this would be “150 mg/dL”) while a severe reading is considered anything over 500 mg/dL.

In a 2020 report, the National Institutes of Health estimated that between 25% to 30% of the U.S. population had abnormal triglyceride levels. When the number creeps up, even to borderline high, it can indicate that there’s a problem with how lipids are being processed in the body. Since that raises serious health risks, it’s essential to monitor how triglyceride numbers are changing, and if necessary, to implement treatment options—especially lifestyle changes.

Read More: What to Know About High Cholesterol in Kids

Potential causes and concerns

High triglycerides are often accompanied by other risk factors for heart disease, such as high cholesterol, diabetes, and smoking. However, they can also be elevated without any of these factors since genetics can play a role, says Dr. Antonio Giaimo, an assistant professor of cardiovascular medicine at Yale University School of Medicine. Triglyceride levels are often higher in men than women, and they tend to increase with age. An elevated reading is often like a clue that something is going awry in the body, he says.

“When we see a very high reading, that can be a sign of another problem, such as hypothyroidism, kidney disease, or poorly controlled diabetes,” he says. “At the very least, that number should be a starting point for figuring out what might be going on, especially if it’s raising other health risks.”

Some medications can temporarily raise triglycerides as well, Giaimo adds. These include antipsychotic drugs, beta blockers, corticosteroids, and oral estrogen, which are all widely used. If triglycerides reach the “high” or “severe” categories, you may need to switch medications to see if that returns your levels to normal.

According to the National Institutes of Health, untreated or uncontrolled high triglyceride levels—a condition called hypertriglyceridemia—may increase your risk of coronary heart disease and stroke, as well as acute pancreatitis. Usually, issues with the pancreas occur when triglyceride levels have been high for a long time, and these can result in hospitalization if inflammation becomes acute.

That said, seeing a high reading once doesn’t necessarily mean you have to pack your overnight bag for a hospital stay. Most notably, triglyceride levels tend to be significantly influenced by your carbohydrate consumption, says Dr. Yu-Ming Ni, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California.

“With food and drinks like breads, rice, pasta, and soda, these get converted in your liver to fat, and triglycerides are often affected by that,” he says. “That’s why, when you’re getting blood work done to determine your cholesterol and triglyceride levels, it’s recommended to be in a fasted state, because carb-rich foods can affect the numbers quite a bit.”

If you have a high reading and it’s the first time seeing that—and especially if you don’t also have high cholesterol—it’s likely your doctor will repeat the test at a different time to make sure it’s an accurate reflection of your triglyceride levels.

The diabetes connection

Triglycerides are an important heart-health marker for everyone, but they’re particularly helpful for those with diabetes, according to Dr. Elkin Nunez, an endocrinologist at Morristown Medical Center in New Jersey.

With diabetes, the body handles food differently, especially carbohydrates and sugars, and that can lead to more triglycerides. In fact, for some people who don’t yet have diabetes but are on the verge of developing the condition, a high triglyceride number can indicate prediabetes and insulin resistance. For those with diabetes, it might be a head’s up that the condition isn’t being controlled effectively. That can set off a ripple effect across multiple systems in the body, especially the cardiovascular system.

The American Heart Association (AHA) notes that high triglycerides are becoming increasingly prevalent in the U.S. and other countries, driven in large part by a rise in Type 2 diabetes cases.

Lipid abnormalities are common in people with diabetes, and can contribute to overall atherosclerotic cardiovascular disease, or ASCVD, Nunez says. That condition can lead to increased risk of heart attacks, strokes, and peripheral arterial disease. ASCVD is the leading cause of morbidity and mortality in people with diabetes, especially those over age 50.

“Although numbers related to A1C, blood pressure, and cholesterol are necessary for determining what care to provide, triglyceride levels can pose an additional risk and are not always talked about or addressed,” Nunez says.

The most common lipid-profile abnormality in patients with diabetes is called the “lipid triad,” he adds. That means elevated LDL cholesterol—often called the “bad kind”—and decreased HDL (“good”) cholesterol, as well as elevated triglyceride levels. Even if someone with diabetes only has elevated triglycerides, that can raise heart attack risk, adds Giaimo, and the effects could be profound.

“People with diabetes who do have a heart attack usually have more severe consequences and a higher risk of death compared to those without diabetes who have a heart attack,” he says. “Prevention of a first event is key, because once you’ve had an attack, it can change the quality of the rest of your life and require more aggressive treatment. It can also put you at higher risk of a second heart attack or stroke.”

Bringing your triglyceride levels down isn’t enough to eliminate risk completely, but Giaimo says it’s part of a larger strategy that can be significant in improving heart health and controlling diabetes.

Read More: How to Lower Your Cholesterol Naturally

Treatment options

Addressing elevated triglycerides depends on several factors, especially whether cholesterol is also an issue. For example, Nunez says your doctor will likely recommend a statin first if you’re experiencing the lipid triad. However, if only your triglycerides are elevated and your cholesterol is normal, it’s possible you’ll be advised to wait and see if lifestyle changes can help improve those numbers. That might also be the case if your cholesterol is only slightly higher than normal.

Whether you have diabetes or not, lifestyle habits are the first-line treatment for high triglycerides, he adds. That includes getting regular physical activity, reducing alcohol consumption, quitting smoking, losing weight if necessary, cutting back on carbs and sugars, and improving sleep habits.

One step that’s been shown to reduce triglycerides naturally is eating foods high in omega-3 fatty acids—especially fatty fish like salmon and albacore tuna—or taking a supplement high in that compound. For example, a 2019 study from the AHA published in the journal Circulation reports that the use of these fatty acids may lower triglyceride levels by nearly 30%.

Using omega-3s as a complement to other healthy habits like exercise and avoiding sugar can potentially lead to even better results, the AHA added. (One note to keep in mind if you’re thinking of putting supplements on your shopping list: The AHA’s research finds that prescription-level omega-3s seemed to be the most effective, compared to what’s available over the counter.)

Another advantage to omega-3 treatment is that you usually see changes within two weeks, adds Quinones-Camacho. However, if triglyceride levels are still too high after two months, that’s when your doctor will likely recommend a prescription option like fibrates. This type of medication, also known as fibric acid, lowers triglycerides by reducing their production in the liver. They’re also helpful for speeding removal of triglycerides from the blood. Because fibrates don’t affect high cholesterol, they’re usually used only in those with severe triglyceride levels who are at particular risk for developing pancreatitis.

If lifestyle changes and fibrates aren’t doing the trick, someone with high triglycerides may be switched to a medication like statins. These drugs work by reducing the amount of cholesterol produced by the liver, and can lower triglycerides by as much as 40%, according to the American Academy of Family Physicians. As with any treatment, what’s effective will depend on your specific conditions, health risks, medical history, and current medication usage.

When should you get checked?

Having slightly elevated triglycerides without any other health issues usually isn’t cause for concern, says Quinones-Camacho. But if you have diabetes, cardiovascular disease, or a family history of heart issues—or if your triglyceride levels are considered very high and stay that way—it’s worth taking steps to bring that number down.

“Much like high cholesterol and high blood pressure, having high triglycerides doesn’t come with symptoms,” she adds. “That’s why knowing your numbers through an annual checkup is essential for staying on track and lowering your health risks.”

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