How can I control my high triglyceride level?

Question

Hello doctor,

My triglyceride levels came back at 620, and my primary care doctor is freaking out about pancreatitis risk. My cholesterol total is 289, with low HDL (High-Density Lipoprotein) at 32. I already had one episode of pancreatitis last year, which was horrible and painful. I am on Fenofibrate now, but my levels are still not coming down enough.

I am trying a low-fat diet, but it is so hard to maintain with my work schedule. I am also pre-diabetic with an A1C (glycolated haemoglobin) at 6.1 and overweight by 50 pounds. family history of heart disease, my dad had a heart attack at 55. The doctor mentioned fish oil and niacin, but I read about flushing side effects. I am concerned about stroke and heart attack risk, especially with all my risk factors. Please tell me, what aggressive treatment plan can bring these numbers down fast?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your triglyceride level is very high. Extremely high triglyceride levels, especially above 1000 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, or hypothyroidism.
Certain medications, like beta-blockers, Thiazide diuretics, some antipsychotics, and steroids, can also elevate triglyceride levels.

At such a high level, you are susceptible to various complications, including

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

While LDL (Low-Density Lipoprotein, 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 your 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 the following things:

Lifestyle modifications such as daily walking and exercise, weight loss, smoking cessation, and limiting alcohol consumption.
Eating more fruits and vegetables.
Avoiding oily and greasy foods, incorporating vegetable oils into your diet, limiting refined sugars and carbohydrates, and consuming more fiber.

Medications to treat high triglycerides include fibrates such as Gemfibrozil or Fenofibrate. Other options include niacin, omega-3 fatty acids, and statins as an add-on therapy. Fish oil can be started in low doses to avoid serious side effects, and if you tolerate it, it can be taken as recommended. Omega-3 fatty acid supplements are tolerated better.

With the family history and your uncontrolled blood lipids, low HDL (High-Density Lipoprotein), prediabetes, weight gain, and history of pancreatitis, 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.