You know your cholesterol score, but what about your triglycerides?

How to keep triglycerides low, along with your risk of heart disease, diabetes and pancreatic cancer

Did your most recent cholesterol test include a measure of your triglycerides? Perhaps your doctor was too busy writing out a prescription for statins to notice this key indicator of disease risk. The consequence of having high cholesterol is a debatable issue, but not so that of triglyerides.

Triglycerides are the fats circulating in your blood. Each triglyceride is formed of three fatty acids attached to a ‘backbone’ of glycerol, a type of sugar.

These fats provide a source of energy, if required. They are also a source of heart disease, diabetes and pancreatitis, if elevated. Raised triglycerides are not inevitable: keeping them within the normal range is a manageable task for almost everyone.

High blood triglycerides is a condition called hypertriglyceridemia (HTG). As many as 33% of American adults have HTG.

What constitutes HTG varies slightly from one source to another, but here’s a standard definition from the Mayo Clinic:

• Normal — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L)

• Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)

• High — 200 to 499 mg/dL (2.3 to 5.6 mmol/L)

• Very high — 500 mg/dL or above (5.7 mmol/L or above)

What are the risks?

When blood fats are high, there is increased likelihood of thickening and stiffness of the artery walls, and this atherosclerosis is a risk factor for stroke, heart disease and heart attack.

With raised circulating blood fat, there’s also a good chance that you have more fat in your pancreas than is good for you.

Many studies have shown that people who have had a heart attack or cardiovascular complications, including atherosclerosis, also have raised pancreatic fat.

In the past it was assumed that a fatty pancreas was due to excess body fat. But recent research suggests that the link between pancreas fat and CVD may be independent of general adiposity. In other words, you could be of normal weight but still have a fatty pancreas.

A conservative estimate is that around 20% of the general population has excess pancreatic fat.

‘While the link between general adiposity and increased CVD risk is well established, the potential role of high intra-pancreatic fat deposition (IPFD) has received limited attention.’

HTG may be a well-known risk factor for heart disease, but less well known is how it is also a risk factor for pancreatitis, or inflammation of the pancreas. Chronic pancreatitis increasess your chances of developing pancreatic cancer by 2 to 3 times that of the general population.

Like everything else that is diet related, rates of chronic pancreatitis are rising everywhere. In the UK they have risen by 18% since the early 1990s.

If severe, pancreatitis can be fatal. The higher the triglycerides, the greater the risk.

Pancreatitis can be sudden and temporary (acute) or long term (chronic). Acute pancreatitis is the most common pancreatic disease in the world. It can be caused by gallstones and excessive alcohol consumption, as well as HTG.

An acute episode can be very painful but usually resolves itself quickly, within a week, although there can be recurring episodes, leading to chronic pancreatitis.

‘HTG poses a significant risk for the development of acute pancreatitis.’

If you’ve been put on statins because of your high cholesterol, have a word with your doctor about your triglycerides. Studies show an association between long-term statin use and acute pancreatitis.

A large global dataset analysis found that patients on statin therapy were significantly more likely to develop acute pancreatitis compared to patients not taking statin therapy.

Not only are cardiovascular disease and pancreatitis linked to elevated triglycerides, so too is metabolic syndrome, as studies consistently show.

Metabolic syndrome is a cluster of symptoms that also include excess abdominal fat, high blood pressure and high blood sugar levels. It is just a step away from type 2 diabetes.

A single episode of acute pancreatitis is not likely to do any permanent damage, but if recurring episodes lead to chronic pancreatitis, in the long term this can cause scarring of the organ.

Scarring means that parts of the pancreas are destroyed and can no longer produce digestive enzymes or insulin. The consequence of this is malabsorption and high blood sugar, leading to diabetes.

How to lower triglyceride levels

Although HTG can be caused by some rare genetic conditions, and certain medications (including diuretics, hormone replacements, retinoids, steroids, beta blockers), diet and lifestyle factors are by far the biggest causes.