Cholesterol and fat

Cholesterol and other fats in your blood are needed for certain body processes. Cholesterol travels to your cells via special carriers called lipoproteins. The total cholesterol reading in a lipid profile test measures the blood cholesterol in all the lipoproteins combined.

• Low-density lipoproteins (LDL) move cholesterol from the liver to other areas of the body. LDL is referred to as the "bad" cholesterol because some of the LDL particles enter the walls of arteries. There, they form harmful cholesterol deposits.

• High-density lipoproteins (HDL) carry cholesterol from body tissues back to the liver where it can be removed from the body. Having plenty of HDL cholesterol means that your body is able to regulate (and reduce) the cholesterol content of body tissues. Cholesterol in HDL has been called the "good" cholesterol.

The source of triglycerides

Food is one source of triglycerides. Your liver also makes them. When you eat extra calories — especially carbohydrates—your liver increases the production of triglycerides.

When you consume—or your body creates—excess triglycerides, they’re stored in fat cells for later use. When they’re needed, your body releases them as fatty acids, which fuel body movement, create heat and provide energy for body processes.

For good health, your triglyceride level should be less than 150 mg/dL. Borderline high levels are 150 to 199 mg/dL. High is 200 to 499 mg/dL. Very high is 500 mg/dL and greater.

Cause for concern

If you have a high triglyceride level, your healthcare provider may have talked with you about taking steps to lower it. This is because some lipoproteins that are rich in triglycerides also contain cholesterol. This can lead to atherosclerosis in people with high triglycerides. A person with high triglycerides often has other risk factors for heart disease, such as age (men over 45 and women over 55), family history, a low HDL level, or diabetes. Very high levels of triglycerides are associated with inflammation of the pancreas. People who are overweight or obese often have higher than normal levels of triglycerides. All these conditions may increase your risk for developing heart disease or of having a heart attack or stroke.

Fortunately, lifestyle changes may help you manage your triglyceride levels and other risk factors for heart disease.

High risk groups

Certain people are at higher risk for problems from high cholesterol. They may need to use one or more anticholesterol medicines along with eating a healthy diet and exercising regularly to reduce cholesterol. The major risk groups include:

• Adults who have had a heart attack or stroke, or some other atherosclerotic disease, a transient ischemic attack (TIA or mini-stroke)), stable or unstable angina, and anyone who has had a procedure, such as angioplasty or bypass surgery, to restore blood flow through a blocked artery

• Adults who have diabetes or a high risk of having a heart attack or stroke and high LDL cholesterol (70-189 mg/dL)

• People who are 21 years of age and older who have an LDL cholesterol level of 190 mg/dL or higher

Exercise

If you are otherwise in good health, one of the best ways to lower triglycerides is with regular exercise. Choose an activity that gets your heart beating faster. Aim for an average of 30 minutes of moderate to high intensity exercise most days of the week. You don’t need to join a gym or buy expensive equipment. Taking a brisk walk every day can work just as well.

Nutrition

Making the following adjustments to your diet also may help:

• Eat and drink less saturated fat. This type of fat comes from animal products, such as red meats and whole-milk dairy foods. Choose lean meats, and replace full-fat dairy items with low-fat and nonfat versions.

• Eat and drink less total fat in your diet. Limit fat calories to less than 30% of your total caloric intake.

• Eat and drink fewer simple carbohydrates, such as table sugar and syrup. Limit your intake of baked goods made with white flour and sugar. Instead, choose complex carbohydrates, such as found in whole-wheat flour, brown rice, and vegetables.

• Eat foods high in omega-3 fatty acids. These fats, found in fish, play a role in helping keep triglycerides down. Salmon, tuna, sardines, and herring all have a lot of omega-3s.

• Get 25 to 30 grams of fiber a day. Fruits, vegetables, and whole grains, such as whole-wheat bread and brown rice, are great sources.

• Cut back on alcohol. For some people, drinking even a little bit can have a big effect on triglycerides. Talk with your healthcare provider about how much, if any, alcohol you may consume.

Weight management

Lose weight, if you’re overweight. Ask your healthcare provider to help you measure your body mass index (BMI) .This is a measurement that relates your height to your weight. You are overweight if your BMI is 25 or greater; you're obese if your BMI is 30 or greater.

Medicine

If changes in your diet and exercise don’t lower your triglyceride level, your healthcare provider may recommend medicines, such as fibrates and marine-derived omega 3 fatty acids. Fibrates (gemfibrozil, fenofibrate) help mainly by lowering triglycerides. They also may lead to modest improvements in LDL and HDL levels. Omega-3-fatty acids, such as found in fish oil and flax seed oil, may also lower triglyceride levels when taken in prescription strength doses. Commercially available preparations are now available that contain high levels of omega 3 fatty acids. The statin medicines commonly used to treat high LDL levels can also reduce triglyceride levels. Nicotinic acid (niacin) is a B vitamin that can also reduce triglyceride levels but is now rarely used given lack of data to support that it can lower the risk for cardiovascular disease. In addition, niacin can be associated with side effects including flushing as well as a possible increased risk for diabetes.

Other changes

High blood pressure and smoking both increase your risk for heart disease. So, work with your healthcare team to manage high blood pressure, and if you smoke, take steps to quit. Talk to your provider about nicotine replacement products and medicines that can help.

If you are in a high risk group, discuss your treatment goals with your healthcare provider. Make sure you understand how your cholesterol and other factors impact your risk of heart disease or other complications. Plan to have regular monitoring and report any side effects from the medicines. Sometimes, you may need more than one medicine to reach your cholesterol goals. Also, make sure you understand how to prepare for cholesterol testing. It often requires that you fast (have nothing to eat or drink) before the blood draw.