Triglycerides: Mother of Meddlesome Particles
Triglycerides are a crucial risk factor for coronary plaque growth, even at levels previously thought to be normal. Dr. Davis discusses why and how this oft-neglected factor can be harnessed to strengthen your program.
While the world obsesses over cholesterol, a potent stimulator of plaque growth is frequently ignored—triglycerides. A subject of controversy in past, the data are now clear: triglycerides spawn unwanted lipoprotein particles that trigger plaque growth. Track Your Plaque members are advised that control of triglycerides is essential to everyone’s plaque control program.
Triglyceride control is crucial if you are interested in gaining control over coronary plaque. Triglycerides should be brought under control at the start of your program. If you are experiencing plaque growth (increasing heart scan scores), seriously reining in triglycerides should be considered.
How important are triglycerides?
For years, the relationship between coronary heart disease and
triglycerides remained muddled by the confounding effects of low HDL. In
other words, increased triglycerides tend to occur alongside low HDL.
This caused many to dismiss the importance of triglycerides. To make
matters even murkier, high triglycerides in some situations generated
high risk for heart disease, while in others it appeared unrelated to
heart disease, even when markedly elevated (in the thousands!).
Thanks to the evolving science of lipoproteins, the issues are
crystallizing. One important fact has emerged: triglycerides are a
critical risk factor for coronary plaque growth, even at levels
previously thought to be normal. Yes, high triglycerides frequently
occur with low HDL, but they also behave independently. High
triglycerides are a common cause of heart disease, even in people with
low or normal cholesterol values. It is crucial that you (and your
doctor) pay close attention to triglycerides if you are to succeed in
controlling your plaque. We urge Members to make triglyceride control a
priority in their program.
Where do triglycerides come from?
The liver produces a particle called “very low-density lipoprotein”, or
VLDL, packed full of triglycerides. The higher your triglycerides, the
more VLDL you will have. Sometimes triglycerides are increased due to
genetic factors. More commonly, triglycerides are high due to excess
weight, indulging in processed carbohydrates, and resistance to insulin
(metabolic syndrome).
VLDL is like that bad kid on the block you want your kids to avoid. VLDL
particles in the blood come into contact with LDL and HDL particles and
they’re never quite the same. When a LDL or HDL particle meet VLDL, the
triglycerides of VLDL are passed on. The result: LDL and HDL become
bloated with triglycerides. Triglyceride-loaded LDL and HDL are a ready
target for a set of enzymes in the blood and liver that reconfigure
these particles into smaller versions, small LDL and small HDL. Recall
that both small LDL and HDL are highly undesirable particles that
stimulate plaque growth.
Although “official” (ATP-III) guidelines suggest that triglycerides over
150 mg are undesirable, we regard any value over 60 mg as high. An ideal
level for an intensive Track Your Plaque approach is <45 mg.
How will I know if I have this pattern?
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