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 levels 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 "normal" cholesterol blood levels?
- What are the 2013 ACC/AHA Guidelines?
- Why is HDL the good cholesterol?
- What are LDL/HDL and total/HDL ratios?
- How can levels of HDL cholesterol be increased?
- What are triglycerides and VLDL?
- Do high triglyceride levels cause atherosclerosis?
- What causes elevated triglyceride levels?
- How can elevated blood triglyceride levels be treated?
- What medications are available to lower cholesterol, lipids, and triglycerides?
- Is lowering LDL cholesterol enough?
What causes elevated triglyceride levels?
High triglyceride blood levels (hypertriglyceridemia) may be genetic or they may be acquired. Examples of inherited hypertriglyceridemia disorders include mixed hypertriglyceridemia, familial hypertriglyceridemia, and familial dysbetalipoproteinemia.
Hypertriglyceridemia can often be caused by nongenetic 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, 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 and increases HDL cholesterol levels and the size of LDL cholesterol particles.
Statins are effective for decreasing triglyceride and LDL cholesterol levels and, to a lesser extent, elevating HDL cholesterol levels.
What medications are available to lower cholesterol, lipids, and triglycerides?
Lipid-altering medications are used to lower blood levels of undesirable lipids such as LDL cholesterol and triglycerides and increase blood levels of desirable lipids such as HDL cholesterol. Several classes of medications are available in the United States, including HMG-CoA reductase inhibitors (statins), nicotinic acid, fibric acid derivatives, and medications that decrease intestinal cholesterol absorption (bile acid sequestrants and cholesterol absorption inhibitors). Some of these medications are primarily useful in lowering LDL cholesterol, others in lowering triglycerides, and some in elevating HDL cholesterol. Medications also can be combined to more aggressively lower LDL, as well as lower LDL and increase HDL at the same time.
Note: Dosing guidelines change. The U.S. Food and Drug Administration (FDA) issued a guideline concerning the potential dangers of taking the 80 mg dose of simvastatin (Zocor).
|Medication Class||Medication Examples||Effects on Blood Lipids|
|Statins||pravastatin sodium (Pravachol), lovastatin (Mevacor), atorvastatin calcium (Lipitor), fluvastatin sodium (Lescol), rosuvastatin (Crestor), simvastatin (Zocor)||Most effective in lowering LDL, mildly effective in increasing HDL, mildly effective in lowering triglycerides|
|Fibric acid||gemfibrozil (Lopid), fenofibrate (Tricor)||Most effective in lowering triglycerides, effective in increasing HDL, minimally effective in lowering LDL|
|Bile acid sequestrants||cholestyramine (Questran), colestipol (Colestid), and colesevelam (Welchol)||Mildly to modestly effective in lowering LDL, no effect on HDL and triglycerides|
|Cholesterol absorption inhibitors||ezetimibe (Zetia)||Mildly to modestly effective in lowering LDL, no effect on HDL and triglycerides|
|Combining nicotinic acid with statin||lovastatin + niaspan (Advicor)||Effective in lowering LDL and triglycerides and increasing HDL|
Historically, niacin has been a one of the medications used to lower cholesterol and decrease the risk of heart attack and stroke. Its usefulness has been called into question by studies conducted in 2011 by the National Institutes of Health. Patients who are taking niacin should not stop using it without discussing treatment options for cholesterol control with their health care professional.
Research to date suggests that only statin medications are effective in lowering the risk of developing heart disease.
Tips to keep it under control.