What You Need to Know About Elevated Triglycerides

Numerous studies have shown a strong, graded and significant relationship of high triglycerides and increased cardiovascular risk. Here’s what you need to know.

Elevated triglycerides are a component of many conditions that increase cardiovascular risk including insulin resistance, metabolic syndrome, diabetes and various genetic disorders.

Meta-analyses of data from 262,525 participants in 29 prospective studies, showing that elevated triglyceride is a strong and independent predictor of cardiovascular risk.1

Prospective population data show the risk for cardiovascular events is greatest as triglyceride increases from 100mg/dL - 200 mg/dL. As triglyceride increases above 200mg/dL, cardiovascular risk increases at a lesser rate.2

In clinical trials, statin treated patients with a history of cardiovascular events show as ignificant increase in risk for recurrent cardiovascular events as triglyceride levels rise above 150 mg/dL on statin therapy.3,4

Although various medications and supplements lower triglycerides (niacin, fibrates, fish oil),very few agents have shown the ability to reduce cardiovascular events.

When added to statin therapy, the only triglyceride lowering therapy proven to reduce future cardiovascular events (heart attack, stroke, coronary stents, coronary artery bypass surgery, and cardiovascular death) is prescription Vascepa (Icosapent ethyl).5

Guidelines from the American Diabetes Association, National Lipid Association, European Society of Cardiology specifically endorse the use of Vascepa to reduce cardiovascular events in statin treated patients with established cardiovascular disease, or type 2 diabetes and ≥1 additional risk factor, and triglyceride levels of 135 - 499 mg/dL.5-7

When triglyceride levels are “very high” -- above 500 mg/dL -- you are more likely to get inflammation in your pancreas. Inflammation of the pancreas (a condition which doctors call pancreatitis) can cause permanent tissue damage. Symptoms can include abdominal pain, which may be severe.

 

References

  1. Sarwar, N., et al. "Triglycerides and the Risk of Coronary Heart Disease: 10,158 Incident Cases among 262,525 Participants in 29 Western Prospective Studies." Circulation 115.4 (2007): 450-8.

  2. Navar AM, Pagidipati N, Mulder H, et al. Triglycerides as a risk factor for coronary heart disease: what measure and what cutoff? Poster presented at: 68th Scientific Session of the American College ofCardiology; March 18, 2019; New Orleans, LA.

  3. Miller, M., et al. "Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol after Acute Coronary Syndrome in the Prove It-Timi 22 Trial." J Am Coll Cardiol 51.7 (2008): 724-30.

  4. Schwartz, G. G., et al. "Fasting Triglycerides Predict Recurrent Ischemic Events in Patients with Acute Coronary Syndrome Treated with Statins." J Am Coll Cardiol 65.21 (2015): 2267-75.

  5. American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43: S111-S134.

  6. Orringer CE, Jacobson TA, Maki KC. National Lipid Association Scientific Statement on the use oficosapent ethyl in statin-treated patients with elevated triglycerides and high or very-high ASCVD risk. JClin Lipidol 2019; 13:860-872.

  7. Mach F, Baigent C, Catapano AL et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis 2019; 290:140-205.