How to manage high triglycerides in a woman?

Question

Hello doctor,

I am a 45-year-old woman who was surprised to learn that my triglyceride levels are very high during a routine check-up. While I have always been slightly overweight, I did not anticipate numbers this concerning. My doctor mentioned the possibility of starting medication, but I would like to focus on lifestyle changes first. I am particularly interested in understanding what strategies are most effective for women, especially considering hormonal fluctuations during perimenopause.

I am uncertain about which foods to prioritize or avoid, and whether approaches like GtR intermittent fasting or omega-3 supplementation are beneficial.
I am also concerned about my long-term heart health, as there is a family history of heart disease.
How quickly can improvements be expected with lifestyle changes, and how frequently should triglyceride levels be monitored?

This situation has left me feeling anxious, and I want to take proactive steps to manage my heart health.

Thank you for your time and support.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

The level of triglycerides should generally be within the normal range, and very high levels, especially over 1000 mg/dL, suggest either a genetic etiology, such as familial hyperlipidemia, or a secondary cause. Possible secondary causes include uncontrolled diabetes mellitus, obesity, physical inactivity, kidney disease or nephrotic syndrome, metabolic syndrome, and hypothyroidism. Medications that can increase triglycerides include beta-blockers, thiazide diuretics, certain antipsychotic medications, and steroids.

High triglycerides carry the risk for the development of pancreatitis, coronary artery disease, narrowing or blockage of the arteries supplying blood to the heart (CAD), and peripheral artery disease, narrowing or blockage of arteries supplying blood to the limbs (PAD). Specifically, low-density lipoprotein (LDL) is considered “bad cholesterol” directly linked to CAD and PAD. However, studies demonstrate that high levels of triglycerides are also implicated in ischemic heart disease and PAD. Very often, hypertriglyceridemia is asymptomatic. However, very high levels may present with symptoms, such as xanthomas (lipid deposits under the skin), lipemia retinalis (lipid deposits in the eyes), pancreatitis, and increased risk for ischemic heart disease.

Management primarily involves lifestyle modifications, including:

Regular physical activity, such as daily walking or exercise.
Weight management.
Smoking cessation.
Limiting alcohol consumption.
Eating more fruits, vegetables, and fiber.
Decreasing intake of oily, greasy foods and refined sugars.
Using healthy vegetable oils in the diet.

If necessary, medications can also be considered, including fibrates like Gemfibrozil or Fenofibrate; Niacin; Omega-3 fatty acids; and Statins as add-on therapy.

High levels of triglycerides do not usually affect menstrual periods. However, fluctuating hormones during perimenopause may impact your lipid profile, which includes triglycerides. Sometimes, HRT may help alleviate high triglycerides; at other times, it can worsen lipid control and may have to be stopped.

Generally, if the levels of triglyceride are above 500 mg/dL, medication is recommended in addition to lifestyle changes. If you prefer to focus on lifestyle modifications first, strict adherence to the diet and activity changes is essential. Lipid levels should be rechecked after approximately three months, and further management can be determined based on the results.

I hope this information is helpful.

Please feel free to reach out if you have any further questions.

Thank you.