Features November 2012 Issue

Triglyceride Screening Guidelines Call for Checks Every Five Years

But those with risk factors should consider more frequent.

High triglyceride levels, known as hypertriglyceridemia, is a risk factor for pancreatitis and other complications, such as coronary heart disease and even stroke. So knowing your levels and taking steps to control your numbers is vital. To help make sure physicians and patients keep up with changes in their triglyceride levels, the Endocrine Society recently issued a Clinical Practice Guideline for the diagnosis and treatment of hypertriglyceridemia.

Triglycerides are a type of fat or lipid found in the bloodstream, and they compose part of your total cholesterol profile, along with LDL (“bad”) and HDL (“good”) cholesterol. Abnormal cholesterol levels represent a condition known as dyslipidemia and constitute a significant risk factor for heart disease and cardiovascular events.

Among the Endocrine Society’s key recommendations is the screening for hypertriglyceridemia as part of a lipid panel every five years. But Cleveland Clinic cardiologist Leslie Cho suggests that anyone with heart disease risk factors should consider annual checks, as recommended by the American Heart Association.

“The American Heart Association recommends every 5-year cholesterol screening after the age of 20, if there are no risk factor for heart disease, but every year if there is a risk of heart disease,” she says. Those risk factors could include obesity, diabetes, hypertension, smoking, family history of dyslipidemia and heart disease, and advancing age.

“Given that elevated triglyceride is a marker of metabolic syndrome, and with our increasing obesity epidemic, it is odd that they would do 5 year screening for all patients,” Dr. Cho says. “I think a better guideline would be every year screening for those with risk factors for heart disease.”

Risks and Causes
Normal triglycerides means there are less than 150 milligrams per deciliter (mg/dL), though optimal triglyceride levels are consider less than 100 mg/dL. Borderline high triglycerides equate to 150 to 199 mg/dL, and high triglycerides are 200 mg/dL or higher.

“High triglyceride has been linked to increase stroke rate in women and increase heart disease in both women and men,” Dr. Cho says. “High triglyceride is mainly caused by dietary indiscretion, such as too many carbs, sweets, sugar, alcohol, etc. But there are secondary causes of hypertriglyceridemia such as hypothyroidism, uncontrolled diabetes, nephrotic syndrome and medications.”
She adds that because the majority of hypertriglyceridemia is related to diet, it is crucial to understand what types of food increase triglyceride and limit your consumption of them.

The new guidelines also stress the importance of evaluating secondary causes of hyperlipidemia if you have elevated levels of triglycerides, as well as investigating other possible heart disease risk factors.

Treatment
Dietary and lifestyle changes are the cornerstones of triglyceride-lowering treatment, and are reflected in the Endocrine Society guidelines. For example, consume a diet composed of fiber-rich complex carbohydrates, such as fruits, vegetables and whole grains, rather than one with too many simple sugars.

Likewise, controlling your high blood pressure and quitting smoking will not just help your lipid profile, but will improve your overall health.

Omega-3 fatty acid supplements may help lower your triglycerides, but Dr. Cho says you shouldn’t look to a pill to make a change, when it’s really diet and exercise that will make the biggest difference. Other medications, such as statins and niacin may also be prescribed, though they are more specifically designed to affect your LDL and HDL levels, respectively. Fibrates are also commonly prescribed for elevated triglycerides, but they may not be appropriate for patients with kidney problems.