What are the reasons for my high triglyceride levels at 51?

Question

Hello doctor,

I am a 51-year-old man struggling with high triglycerides for the last two years. My latest lipid profile shows triglycerides at 420 milligrams per deciliter (mg/dL), High-density lipoprotein (HDL) at 32 mg/dL, and Low-density lipoprotein (LDL) at 108 mg/dL. I have been on Fenofibrate for a few months, but my values have not improved much. I have a strong family history of heart attacks and am slightly overweight. I have started exercising regularly, but I find it difficult to maintain a strict low-carbohydrate diet. Please tell me,

Should I consider adding omega-3 fatty acids or statins?
Is there a possibility that my thyroid or sugar levels are contributing to this issue?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your triglyceride level is high. Extremely high triglyceride levels (attachments are removed to protect privacy), especially above 1000 milligrams per deciliter (mg/dL), can indicate either a genetic predisposition, such as familial hyperlipidemia, or a secondary cause. These secondary causes include

Uncontrolled diabetes.
Obesity.
A sedentary lifestyle.
Renal disease.
Nephrotic syndrome.
Metabolic syndrome.
Hypothyroidism.
Certain medications, like beta-blockers, thiazide diuretics, some antipsychotics, and steroids, can also elevate triglyceride levels.

With high triglyceride levels, you can be susceptible to various complications, including

Pancreatitis.
Coronary artery disease (CAD).
Peripheral artery disease (PAD).

While Low-density lipoprotein (LDL) (also known as bad cholesterol) has a direct relationship with CAD and PAD, data also show that patients with elevated triglyceride levels are prone to ischemic heart disease and PAD.

Hypertriglyceridemia is usually asymptomatic, but when levels are extremely high, patients may develop xanthomas. These are lipid accumulations under the skin that appear as bumps. Lipids can also accumulate in your eyes (lipemia retinalis), cause pancreatitis, and increase your susceptibility to ischemic heart disease.

Your treatment primarily involves

Lifestyle modifications such as daily walking and exercise, weight loss, smoking cessation, and limiting alcohol consumption.
You should eat more fruits and vegetables, avoiding oily and greasy foods.
Incorporating vegetable oils into your diet, limiting refined sugars and carbohydrates, and consuming more fiber are important. If diabetes and thyroid issues are present, they need to be solved under the supervision of an endocrinologist to treat lipids adequately.
Medications to treat high triglycerides include the fibrate class of drugs, such as Gemfibrozil or Fenofibrate. Other options include niacin, omega-3 fatty acids, and statins as an add-on therapy.
Your High-density lipoprotein (HDL) is a bit low, and your LDL is within an acceptable range. I would not recommend statins right away. You can take Omega-3 fatty acids or fish oil for now and see if there are good results along with Fenofibrate. You can also take Gemfibrozil 600 milligrams twice daily instead of Fenofibrate, as switching to Gemfibrozil may yield better results.

With a significant family history, uncontrolled blood lipids, and being overweight, it is very crucial to keep a close eye on your health indicators.

I hope this information helps you.

Feel free to ask further queries.

Thank you.