What are triglycerides?

• Triglycerides are a common type of fat- in fact they make up about 95% of dietary fats, including animal and vegetable-based fats.
• As your body digests food, triglycerides enter the bloodstream, where they can be used as a source of energy to fuel the body. If not used up, they get stored in fat cells. If energy is needed between meals, it can be released from these fat stores.
• The average lean adult has approximately 15kg of triglycerides stored in their body- this can supply enough energy to last around 3 months!
• However, if you have an unhealthy diet, and tend to eat more calories than you burn, it may cause high triglycerides in your bloodstream- this is known as hypertriglyceridaemia.

What causes high triglycerides?

High triglycerides are often the result of unhealthy eating and lifestyle, but can also be a sign of other issues, for example

• poorly controlled type 2 diabetes
• hypothyroidism (an underactive thyroid gland)
• liver disease
• kidney disease
• a side effect of medications, including beta blockers, the contraceptive pill, steroids and diuretics.
• familial or genetic conditions (e.g. familial hypertriglyceridaemia)

What are normal triglyceride levels?

A fasting blood test can show whether your triglycerides are normal- this is usually done as part of a routine fasting cholesterol test (also known as a fasting lipids profile).

• Normal triglyceride levels are less than 1.7 mmol/L.
• 1.7 to 2 mmol/L is considered borderline high
• High levels are 2 to 6 mmol/L
• Very high levels are 6 mmol/L or higher

What is the treatment for high triglycerides?

Reducing triglycerides (and cholesterol) is important, but it’s only one aspect of lowering your overall risk of heart disease and stroke. For example, if you are obese, a smoker, or have poorly controlled diabetes or high blood pressure, it’s vital that these issues are managed too.

If you have high triglycerides, often the first thing your doctor will recommend is a variety of lifestyle changes:

• Achieve a healthy weight through health eating and more exercise (try for 30 minutes of dedicated exercise per day)
• Make sure your daily calorie intake is not more than you need- avoid saturated fats (present in takeaway, fried and processed foods) and sugary foods.
• Try to eat more “healthy fats” such as olive and canola oils, and oily fish such as mackerel and salmon.
• Reduce alcohol consumption- even relatively small amounts of alcohol can increase your triglycerides.
• Quit smoking, make sure your blood pressure is normal, and if you have diabetes ensure it’s well controlled.

Medication:

The decision to start a medication is not just based on the “number” of your cholesterol or triglycerides, but on your overall risk of heart disease and stroke. Your doctor may use a special calculator to figure this out, and will take into account things like overall cholesterol levels, smoking status, family history and other condition such as high blood pressure or diabetes.

It’s not yet proven whether treating high triglycerides with medication reduces risk of heart disease, but if you have other risk factors, or your triglycerides are above 6mmol, your doctor may recommend it.

• Statins are medications that are often used to treat high LDL cholesterol, to reduce a person’s risk of heart attack and stroke. If LDL and triglycerides are both raised, statins may be advised.
• Fibrates are another class of medication which can be used as treatment for high triglycerides- they tend to be used if levels are still high (above 6 mmol/L) or in situations where triglycerides are raised but LDL is normal.
• Omega-3 fatty acids contained in fish oils may reduce triglycerides, but large doses are needed to achieve this effect- therefore they’re used in cases where triglycerides are particularly high (e.g. above 6 mmol/L). High doses of fish oils may lead to side effects such as an upset stomach, belching, and a fishy taste in the mouth.
• Niacin (also known as nicotinic acid) may also be advised in cases where triglycerides are above 6mmol/L. Whilst available as an over-the-counter supplement, it should not be started without consulting your doctor, as it can interact with other medications.

When should you see a specialist about your high triglycerides?

If triglycerides are above 10mmol/L, it may indicate familial hypertriglyceridaemia or some other underlying cause. In this situation, a referral should be considered to a Lipid Clinic or cardiologist.

People with extremely high triglycerides are at risk of a serious condition called “acute pancreatitis”, so it’s very important that treatment is attempted in these cases.

What are the key points to take away about high triglycerides?

• Treatment involves looking at all your cardiovascular risk factors- quit smoking, make sure you’ve got normal blood pressure, maintain a healthy weight, enough exercise, health eating and avoid excess alcohol intake.
• Sometimes medication may be advised- for example, if your levels are very high, or if you have a high overall risk of heart attack and stroke, including a strong family history.
• More research is needed about the links between high triglycerides and heart attack and stroke, and the benefits of medication.

We need cholesterol!

First of all, it’s important to understand that cholesterol itself is not bad. In fact, it’s essential for life! Cholesterol is a fatty substance which is used by the body in many vital processes:

• to build cell membranes
• to make bile acids, which digest food
• to make hormones (like oestrogen and testosterone)
• to allow the body produce Vitamin D

However, the body can make its own cholesterol- so you don’t need to get it from food sources. If you eat too much unhealthy fatty food, the cholesterol levels in your blood may increase and cause problems.

What are the different types of cholesterol?

• There are different forms of cholesterol. LDL cholesterol is sometimes known as “bad cholesterol” as it is linked to a higher risk of vascular disease, such as heart attack and stroke. This is because high LDL cholesterol (along with other risk factors such as smoking and high blood pressure) can lead to blockages in blood vessels.
• HDL cholesterol is also known as “good cholesterol” as it helps to transport cholesterol out of the bloodstream- higher levels of HDL cholesterol are associated with a lower risk of heart disease.
• If you have a blood test to check your cholesterol (also known as lipids), the results will usually include measurement of total cholesterol, LDL, HDL and triglycerides.

What are normal cholesterol levels?

• Total cholesterol and LDL cholesterol (sometimes known as “bad cholesterol) tend to be the focus of discussion when blood tests are done.
• Normal total cholesterol is less than 5mmol/L
• Normal LDL is less then 3mmol/L, but basically, the lower the better.
• However, in people who have other risk factors (for example, diabetes), the ideal or target levels for total and LDL cholesterol are lower.
• HDL cholesterol should ideally be above 1.6mmol/L

When should cholesterol be treated with medication?

• The decision to start a medication depends on a person’s overall risk of heart disease and stroke (cardiovascular disease)- it’s different for different people.
• A cardiovascular risk calculator can be used to figure out your risk of getting a heart attack or stroke in the next 10 years, based on your cholesterol results and other risk factors- this can help your doctor to decide if you’re low, moderate or high risk.:
• Low risk: If risk is low (less than 10% risk of heart attack or stroke in the next 10 years), then it’s reasonable to try lifestyle changes (see below) and retest in 5 years
• Moderate risk: If risk is moderate (10-15% risk of heart attack or stroke in the next 10 years), then lifestyle changes can be tried at first- if there is no significant improvement in cholesterol levels after 6 months of healthy lifestyle changes, medication may be considered. However, a decision may be made to go straight for medication if a person is in a high-risk group- for example if they are of South Asian, Pacific Islander, Maori, Middle Eastern, Aboriginal or Torres Strait Islander descent, or if they’ve a strong family history of heart attack or stroke in younger people. Lipids (cholesterol) blood tests should be repeated every 2 years in this group.
• High risk: If risk is high (over 15% risk of heart attack or stroke in the next 10 years), then both lifestyle changes AND medication should be considered. A lipid profile (cholesterol) blood test should be repeated every year.
• However, it’s important to note that some people are “high risk” purely because they have certain health issues, and may be advised to start cholesterol-lowering medication on this basis- for example if they have significant chronic kidney disease, complications from diabetes, high blood pressure (above 180mmHg systolic), familial hypercholesterolaemia, or total cholesterol above 7.5mmol.

What are the recommended lifestyle changes if you have high cholesterol?

Lifestyle changes are aimed at reducing all risk factors that contribute to cardiovascular disease, and include the following:

• Quit smoking. Smoking allows LDL cholesterol to enter blood vessel walls more easily and cause damage.
• Healthy eating
• Increase exercise. Regular exercise appears to increase HDL levels while reducing LDL and triglycerides.
• Ensure blood pressure is normal
• Maintain a healthy body weight
• Look after your mental health- people who have depression or who are socially isolated may have a higher risk of cardiovascular disease- speak to your GP if you think this applies to you.
• If you have diabetes, ensure that your blood glucose control is good, and attend your doctor for regular check ups.

What foods should be avoided if you have high cholesterol?

• The key is to avoid unhealthy “trans fats” and saturated fats (check food labels for these) as they will push up LDL. It’s also important to source “good fats”, for example plant-based sterols. Cholesterol itself is present in foods but is not as harmful as trans and saturated fats.
• In the past, eggs were demonised as being high in cholesterol, but it’s now been shown that eggs are very nutritious and are not a major problem if you have high cholesterol, as they don’t affect LDL much. It’s OK for most people to have up to 6 eggs per week.

Foods that may lower cholesterol levels

LDL cholesterol may be lowered by certain foods:

• Polyunsaturated oils (e.g. sunflower oil and safflower oil).
• Oats
• Legumes
• Saponins- present in chickpeas and alfalfa sprouts
• Allicin- present in garlic and onions
• Plant sterols in cereals, fruit and vegetables
• Margarine and dairy products enriched with plant sterols

For more detailed information on lifestyle and dietary changes if you have high cholesterol, click here 

If you have concerns about high cholesterol or cardiovascular disease, speak to your doctor.

Would you recognise the symptoms of a heart attack?

• Every year, around 55,000 Australians get a heart attack, and about 9000 of these people die- that’s one per hour!
• In many cases, the heart attack comes out of the blue, with absolutely no warning signs beforehand.

What is a heart attack?

• A heart attack is when a blockage occurs in one of the blood vessels that supply the heart with blood (the coronary arteries).
• Usually this happens because a cholesterol plaque has built up inside the artery over time- this build-up ruptures and causes a blood clot to form, leading to a blockage of the artery. The heart muscle cannot get oxygen, and starts to die.
• These days, if someone is having a heart attack there are highly effective clot-busting treatments that can be carried out in hospital. These treatments aim to get blood circulation back to the heart muscle as quickly as possible.
• Early treatment reduces the risk of permanent damage to the heart, and can save lives.

The first important step is knowing the symptoms of a heart attack looks. While some people get the classic chest pain, other people may get milder or less typical heart attack symptoms.

How to be prepared

• Being familiar with heart attack symptoms and what to do (see above).
• If you’ve had a heart attack before, or have known heart disease/angina, keep an action plan on your fridge or somewhere easy to see.
• You may wish to take out ambulance cover
• Tell your family and friends about the warning signs of heart attack and what to do
• See your doctor to have your cardiac risk factors checked.

How to reduce your risk of having a heart attack

• Quit smoking (just one year after quitting, your risk of coronary disease is cut in half!)
• Get your blood pressure checked- if it’s high, you may need treatment- speak to your doctor
• Maintain a healthy weight
• Get enough exercise – even walking for 30 minutes day will reduce your risk.
• Get your cholesterol checked, especially if you’ve got a strong family history of heart disease or stroke
• If you have Diabetes, be sure to manage it well- your GP can help you monitor your diabetic control and can help you improve it if it’s not as good as it should be.

For more information on heart health, check out https://www.heartfoundation.org.au/ or speak to your GP.