Triglycerides: A Seldom-Acknowledged Part of Lipids


Triglycerides (TG) are a less commonly known part of the lipid profile. The usual emphasis has been more on cholesterol and less on TG. A TG molecule is a combination of three molecules of fatty acids plus glycerides. It is the most common form of fat that humans digest.

TGs are a significant risk factor for coronary heart disease irrespective of so-called bad cholesterol/low density lipoprotein (LDL) and other established risk factors, especially in women. Similarly to elevated levels of fasting TGs, very high levels of non-fasting TGs may also increase the risk for coronary heart disease.

It is still uncertain whether TGs are an independent risk factor for heart disease.[1] It seems to be clear that the risks for heart disease are amplified if high TGs are combined with high LDL and total cholesterol.

Classification of Serum Triglycerides (mg/dL)

<150                        Normal

150-199                 Borderline high

200-499                High

>=500                    Very high

In the Framingham Offspring Study, 11.7% of women and 22.3% of men had TG levels that were higher than 200 mg/dl (2.26 mmol/L). High TGs are the third leading cause of acute pancreatitis, after gallstone disease and alcohol. In patients with high TG levels (>=500 mg/dl [5.65 mmol/L]), the primary therapy goal is to reduce the TG blood level to prevent pancreatitis. The risk of pancreatitis is significantly increased if the TG level is above 1000 mg/dl (11.3 mmol/L).

Fat tissue disease

Increased calorie intake can result in excessive enlargement of the visceral fat cells and result in fat tissue disease and dysfunction. Physiologically, this fat tissue disease results in adverse metabolic and immunological effects such as high blood pressure, diabetes mellitus, and lipid abnormalities.

Obesity, specifically central obesity, is associated with higher levels of TGs and decreased levels of high density lipoprotein (HDL).[2]


Changes in lifestyle habits are first-line therapy for all lipid disorders, including elevated TGs. A regular exercise schedule consisting of at least 30 minutes of moderately intense physical activity (e.g., brisk walking), smoking cessation, restriction of alcohol use, and avoidance of high carbohydrate diets may help to reduce TG levels in blood.

Non-pharmacological Therapies for High TGs

Regular exercise:Consisting of at least 30 minutes of moderately intense physical activity (e.g., brisk walking) per day
Low carbohydrate diet:Limited consumption of bread, rice, potatoes, noodles, and sweets
Restriction of alcohol use:To not more than one drink per day for women and up to two drinks per day for men
Increase fish intake: 4 g of omega-3 fatty acids per day


The American Heart Association, the U.S. Department of Agriculture, and the Department of Health and Human Services recommend regular consumption of fatty fish (salmon, tuna, herring, sardines, mackerel, and trout) that provide omega-3 fatty acids (docosahexanoic acid [DHA] and eicosapentaenoic acid [EPA]). Eating eight ounces of fatty fish per week provides an average of almost 500 mg/d DHA and EPA.

Treatment consisting of 4 g of omega-3 fatty acids per day resulted in a median reduction of TGs of almost 45%.[3] For patients who have severe hypertriglyceridemia (TG>= 500mg/dl), therapeutic options recommend lowering triglycerides by including in the patient’s diet 4g/d omega-3 fatty acids, fibrates, high doses of niacin and, if needed, high doses of statins.[4]


1. Hokanson, J.E. and M.A. Austin, Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk, 1996. 3(2): p. 213-9.

2. Despres, J.P. and I. Lemieux, Abdominal obesity and metabolic syndrome. Nature, 2006. 444(7121): p. 881-7.

3. Harris, W.S., et al., Safety and efficacy of Omacor in severe hypertriglyceridemia. J Cardiovasc Risk, 1997. 4(5-6): p. 385-91.

4. National Cholesterol Education Program Expert Panel on Detection, E. and A. Treatment of High Blood Cholesterol in, Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 2002. 106(25): p. 3143-421.


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