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Cholesterol Management 101

with Michael Richman, MD, FACS

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Friday, April 29, 2011

Triglycerides and Cardiovascular Disease

An Analysis of the Scientific Statement from the American Heart Association

Cardiovascular disease is the leading killer of men and women in the US. Despite the fact that over 150 million lipid panels are done annually, the prevalence of cardiovascular disease continues to grow in this country.

Last week in the online version of Circulation, the Journal of The American Heart Association, a scientific statement about triglycerides and cardiovascular disease was released. This document, to be published in the journal form on May 24, 2011, was the result of two National Institutes of Health evidence-based consensus conferences that evaluated the role of triglycerides in cardiovascular risk assessment and provided recommendations for treatment in those individuals with high triglycerides.

The purpose of this statement is to update physicians about the increasingly important role of triglycerides in the evaluation and management of cardiovascular risk and to educate about the different approaches aimed at minimizing the adverse consequences of high triglyceride levels.  It is hoped that this statement will be used by the Adult Treatment Panel IV (ATP IV) of the National Cholesterol Education Panel, when NCEP issues new evidence based guidelines for the assessment and treatment of lipid disorders in November of this year.

For over thirty years, the extent to which triglycerides directly promote cardiovascular disease has been debated. Despite the success of the “Know Your Numbers” public awareness campaign to educate the public about the increased cardiovascular risk of having high cholesterol levels, mean triglyceride levels have risen steadily in the US since 1976. This is attributed to the growing epidemic of obesity, insulin resistance, and type 2 diabetes mellitus. Overall, 31% of the US adult population has elevated triglyceride levels, with Mexican Americans having the highest rates, followed by non-Hispanic whites, and blacks.

This AHA scientific statement reaffirms the fact that triglycerides are not directly atherogenic (artery clogging), leading to heart attacks and strokes, but rather it points out that an elevated level serves as a biomarker of cardiovascular risk because of the association of high triglycerides and atherogenic lipoprotein particles which do cause atherosclerosis.

I have talked at great length in other articles, on the radio, and on television about the importance of performing advanced lipoprotein testing. This is a way of testing one’s lipid levels in order to quantify the levels of the different lipoproteins in the blood that actually drive the cholesterol and triglycerides through the bloodstream and into the artery wall and are the cause of atherosclerosis. While a detailed explanation of this topic is beyond the scope of the article, you can go to the Center for Cholesterol Management to learn about this most important topic.

The AHA statement states that current ways of testing may underestimate the true atherosclerotic vascular risk and recommend that one look at lipoprotein concentrations in individuals with high triglycerides and abnormalities of HDL cholesterol levels (the good cholesterol) to better ascertain risk.

The AHA also suggests that current levels of triglyceride levels, defined as normal, be revised and lowered in accordance with new evidence from multiple clinical studies. Therapeutic lifestyle changes (TLC) including diet modification, exercise, weight loss, and smoking cessation are the first the first line treatment of elevated triglycerides. A 5-10% reduction in body weight anticipates a triglyceride lowering response of 20%. Many people, however, require medications in conjunction with TLC to achieve optimal triglyceride levels.

Posted by: Michael Richman, MD, FACS at 7:06 am

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