Cholesterol (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Cholesterol facts
- What is cholesterol?
- What are LDL and HDL cholesterol?
- What determines the level of LDL cholesterol in the blood?
- Does lowering LDL cholesterol prevent heart attacks and strokes?
- How can LDL cholesterol levels be lowered?
- What are the current NCEP cholesterol treatment guidelines?
- Why is HDL the good cholesterol?
- What are triglycerides and VLDL?
- What medications are available to lower cholesterol, lipids, and triglycerides?
- Is lowering LDL cholesterol enough?
- Pictures of Cholesterol Levels - Slideshow
- Take the Cholesterol Quiz
- Lowering Cholesterol 15 Tips Slideshow Pictures
- High Cholesterol (Hyperlipidemia) FAQs
- Find a local Internist in your town
What are triglycerides and VLDL?
Triglyceride is a fatty substance that is composed of three fatty acids. Like cholesterol, triglyceride in the blood either comes from the diet or the liver. Also, like cholesterol, triglyceride cannot dissolve and circulate in the blood without combining with a lipoprotein.
The liver removes triglyceride from the blood, and it synthesizes and packages triglyceride into VLDL (very low-density lipoprotein) particles and releases them back into the blood circulation.
Do high triglyceride levels cause atherosclerosis?
Whether elevated triglyceride levels in the blood lead to atherosclerosis and heart attacks is controversial. While abnormally high triglyceride levels may be a risk factor for atherosclerosis, it is difficult to conclusively prove that elevated triglyceride by itself can cause atherosclerosis. Elevated triglyceride levels are often associated with other conditions that increase the risk of atherosclerosis, including obesity, low levels of HDL- cholesterol, insulin resistance and poorly controlled diabetes mellitus, and small, dense LDL cholesterol particles.
What are the causes of elevated triglyceride levels?
High triglyceride levels may be genetic or they may be acquired. Examples of inherited hypertriglyceridemia (hyper=high + triglyceride + emia= in blood) disorders include mixed hypertriglyceridemia, familial hypertriglyceridemia, and familial dysbetalipoproteinemia.
Hypertriglyceridemia can often be caused by non-genetic factors such as obesity, excessive alcohol intake, diabetes mellitus, kidney disease, and estrogen- containing medications such as birth control pills.
How can elevated blood triglyceride levels be treated?
Diet is the first step in treating hypertriglyceridemia. A low fat diet, regular aerobic exercise, loss of excess weight, reduction of alcohol consumption, and stopping cigarette smoking may be enough to control triglyceride levels in the blood. In patients with diabetes mellitus, meticulous control of elevated blood glucose is also important.
When medications are necessary, fibrates (such as Lopid), nicotinic acid, and statin medications can be used. Lopid not only decreases triglyceride levels but also increases HDL cholesterol levels and LDL cholesterol particle size. Nicotinic acid lowers triglyceride levels, increases HDL cholesterol levels and the size of LDL cholesterol particles.
The statin drugs have been found effective in decreasing triglyceride as well as LDL cholesterol levels and, to a lesser extent, in elevating HDL cholesterol levels.
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