Are low triglyceride levels suggestive of an autoimmune disease?

Hello,

Welcome to icliniq.com.

I understand your concern. Kindly answer the below questions:

1.Why did you see a cardiologist?

2. Do you follow any specific diet?

3. Do you have any medical conditions?

4. Why was the 24 hours urine iodine checked?

5. Are you on any medications?

I suggest you repeat the lipid profile in ten hours fasting state. Also, get TSH (thyroid-stimulating hormone), free T4 (thyroxine), anti-TPO antibody (thyroid peroxidase), complete blood count, and ESR (erythrocyte sedimentation rate) done.

Kindly revert in case of further questions.

Thank you.

Hello,

Welcome back to icliniq.com.

Being on a ketogenic or carbohydrate-restricted diet has caused high total cholesterol, high LDL, and low triglycerides. Please send your previous lipid profile. If you are lean or muscular, you may have a phenotype described as a "Lean mass hyper responder" who reacts to a low carbohydrate diet with lipid changes. However, whether this lipid profile confers higher or lowers cardiac risk is still unknown. I suggest stopping all supplements for at least five days before the blood tests, as supplements like biotin can interfere with the results. I do not think that low TG by itself is worrisome. Among all, LDL (low-density lipoprotein) is important. I suggest you ask your cardiologist about CT coronary scoring, measuring small dense LDL, Apo A/B, lipoprotein 'a', and lipid NMR spectroscopy.

I hope this helps.

Thank you.

Hi,

Welcome back to icliniq.com.

The thyroid blood tests (attachments removed for patient identity protection), including the antibody and ESR (electrolyte sedimentation rate), are normal. I think that by following the Mediterranean diet, the total cholesterol and low-density lipid will go down. I reviewed your previous blood tests, and nothing stands out except the lipid profile. Once other tests are done, we can review them. How bad is the family history of heart disease? It is rather surprising that, at your age, you are very conscious of these parameters.

Thank you.

Hi,

Welcome back to icliniq.com.

The genetic reports are all new to me (attachments removed for patient identity protection). You are right that being in the top 25th percentile for CV risk is concerning. The apo B levels are not high - so we can make the assessment that you do not have more low-density lipid particles, especially the smaller ones. The high low-density lipid is due to the ketogenic diet and probably has large low-density lipid particles. The low-density lipid (a) is slightly high.

1. Statin will reduce low-density lipids, and Ezetimibe may be added to statin to lower low-density lipid if needed. Statin may cause insulin resistance and, in a few people, muscle aches and, very rarely, liver toxicity.

2. PCSK9 inhibitors will reduce low-density lipid and low-density lipid (a). They can cause a variety of side effects also.

3. Supplements like red yeast rice will help slightly lower low-density lipid.

Now my recommendation:

1. Repeat fasting lipids on the Mediterranean diet for three months and see where the low-density lipid is.

2. Start a statin at a low dose (for primary prevention, I prefer well-known, time-tested medicines).

3. Monitor lipids periodically and reassess and modify the treatment plan.

Thank you.

Hi,

Welcome back to icliniq.com.

Although not mandatory, check liver function tests, creatine kinase level, high sensitive CRP, fasting glucose and fasting insulin (for HOMA-IR calculation) and lipid levels before and three months after starting a statin. Sex hormones are not usually checked. The positive effects of statins beyond LDL reduction are not usually clinically or biochemically measured. If you look up, there are a lot of negative images on statins. However, we do not know what real or myth about some of them (evidence lacking, ambiguous or inconclusive) is. On the risk-benefit balance in your case, the scale tilt towards benefit.

Thank you.