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A Drug-Free Solution to Elevated Blood Triglycerides
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Increased Risk of Heart Attack
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For every percentage your triglyceride level drops, so can your chance of heart disease.
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Triglycerides have been well established as a risk factor for coronary artery disease (CAD) for several decades. As early as 1959, higher serum triglyceride levels have been reported in patients with CAD.
Although nearly two-thirds of all coronary heart disease cases in the United States can be at least partly blamed on abnormal triglycerides, triglycerides as a major cause of heart disease have been frequently ignored or neglected (W. Davis, M.D., Lowering Triglycerides and Raising HDL Naturally. Le Magazine, December 2004)
For many years, the importance of triglycerides was a subject of debate. Until the early 1990s, triglycerides were not considered a great threat, so they have been sort of a neglected issue.
For a long time, triglycerides were overshadowed by other blood lipids, in particular, by low-density lipoprotein. In regard to cardiovascular disease, LDL-"bad" cholesterol was considered more important than triglycerides.
In 1994, a research group from University Of Southern California triggered a heated debate in the medical community with the publication of a study linking triglycerides to coronary artery disease, which accounts for 200,000 deaths each year.
Writing in the American Heart Association's journal Circulation, the USC scientists reported that bad cholesterol-LDLs-appeared to be masking arterial damage caused by triglyceride-rich lipoproteins called Very Low Density Lipoproteins (VLDL) and Intermediate Density Lipoproteins (IDL).
Some triglyceride particles, however, lead to atherosclerosis and others may not. This remains mystery to researchers.
The study found that despite aggressive treatment of the bad cholesterol, patients with high triglycerides continued to suffer damage to arterial walls. Using state-of-the-art imaging techniques and specific tests, the scientists found that VLDL and IDL were the culprits.
The danger is similar to not changing the oil in a car. When neglected, both blood and oil get thick, which makes the heart or engine work harder to pump the fluid. The fluid also picks up excess debris and tends to form nasty deposits, which ultimately cause a breakdown. An engine will burn up. In humans, the end result is a heart attack or a stroke.
Recent evidence strengthens the connection between high triglycerides and heart disease. A Harvard-lead study author reported:
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"High triglycerides alone increased the risk of heart attack nearly three-fold. And people with the highest ratio of triglycerides to HDL -- the "good" cholesterol -- had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL in the study of 340 heart attack patients and 340 of their healthy, same age counterparts.
The ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio." (Circulation 1997;96:2520-2525).
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However, association between triglycerides and HDL cholesterol is the most difficult to sort out. It turns out that whenever triglycerides are increased, beneficial high-density lipoprotein (HDL) cholesterol decreases.
So is the increased risk seen with high triglycerides due to the triglycerides themselves, or to the associated reduction in HDL cholesterol (the"good" cholesterol) and increase in LDL cholesterol (the "bad" cholesterol). So far, nobody can say for sure.
The problem is, people with elevated triglyceride levels almost invariably have other major risk factors for heart disease (mainly obesity, diabetes, and/or high blood pressure), and, so far, it has not been possible to sort out whether the triglycerides themselves pose an independent risk.
Unlike cholesterol, triglyceride particles are large and do not enter the blood vessels and contribute to arterial blockages in the same way cholesterol does.
Still, high triglyceride levels do indicate a defect in the system and recent evidence strongly suggests that they are a significant risk factor for cardiac disease - an early warning of heart trouble.
According to some experts, when triglycerides are at level 60 mg/dL or higher, several abnormal hidden particles begin to appear in the blood:
- very low-density lipoproteins (VLDL)
- intermediate-density lipoproteins (IDL), and, perhaps most important,
- “small” low-density lipoproteins (small LDL alone can triple risk for heart attack).
Therefore, elevated triglycerides trigger a whole cascade of ill effects that cause coronary plaques to grow leading to heart attacks.
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The Copenhagen Male Study
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The New England Journal of Medicine HealthNews (May 11, 1998), highlighted a Danish study involving 3000 healthy men. This study, called the Copenhagen Male Study, found that the risk of having a first heart attack was twice as high in those with the highest triglyceride levels, compared to those with the lowest levels.
Triglyceride levels can range over 1000 (over 5000 in very extreme cases), but the Danish study found that the risk of heart attack substantially rose at levels above 140. (Most doctors consider 100 or less ideal).
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The Helsinki Heart Study found that people with a high blood triglycerides level alone - that is that the participants had no other risk factors for heart disease - had about a 50% increased risk for coronary artery disease, compared to people with normal levels.
However, they had a 300% greater risk for coronary artery disease when they had both high blood triglyceride levels combined with high levels of LDL cholesterol.
Add borderline high blood pressure, too (140/90 mmHg or greater), and those people suffered a 500% increase! See the chart below.
Presence of excess triglycerides in the blood causes the viscosity (thickening) of blood and reduces the ability of arteries to enlarge. Each time, after high fat meals, your systemic arterial compliance (SAC) becomes decreased, what reflects primarily the stiffness of the aorta - the more stiff the aorta, the worse (Journal of the American College of Cardiology, June 1, 2000).
Triglycerides in higher amounts are significantly interrelated to metabolism of HDL-"good" and LDL-"bad" cholesterol. They make the blood
- more "sluggish" and
- less capable of transporting oxygen to the tissues, particularly through the smallest blood vessels.
Therefore, elevated triglycerides are atherogenic - much more prone to becoming a part of artery-clogging atherosclerotic plaque leading to a heart attack or stroke.
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High Triglycerides in Post-menopausal Women
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Most often high triglycerides are associated with an increase in LDL cholesterol (the "bad" one) and a decrease in HDL cholesterol (the "good" one).
In older women, the relationship between high triglycerides, low HDL cholesterol and heart disease is quite strong. In fact, it is so strong that a high triglyceride level in post-menopausal women is now considered by many as an independent risk factor for heart disease - with levels above 190 mg/dL (2.15 mol/L) denoting increased risk (in males, the danger level starts over 400 mg/dL, or 4.5 mmol/L).
Before menopause, women normally have higher HDL cholesterol levels than men. It is believed that high HDL cholesterol is protective against heart disease and that pre-menopausal women are somewhat "immune" to the disease. After menopause, most women normally have a decrease in HDL cholesterol and an increase in LDL cholesterol.
However, high triglycerides, whether in women or men, could indicate abnormalities or could simply reflect changes in blood lipoproteins and cholesterol that we all experience with age. If a person has high triglycerides and a low HDL level, he or she likely needs further examination.
Although triglycerides plasma (serum) is now generally accepted as an independent risk factor for coronary artery disease (Linton MF and Fazio S. Am J Cardiol. 2003; 92(1A): 19i-26i), according to Robert H. Eckel, professor of medicine at the University of Colorado Health Sciences Center, epidemiological studies indicate that triglycerides rather are a marker for other factors that impact heart disease, just as open umbrellas are not the cause of rain but markers thereof.
In other words, high triglyceride levels usually point to other abnormalities.
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The Need to Reduce "Desirable" Triglyceride Levels
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Cardiologists at the University of Maryland Medical Center have developed more evidence that the “normal” or “desirable” levels of triglyceride may still pose a significant risk of heart disease. The study provides a potential rationale for advocating much lower fasting triglyceride levels than those currently considered “desirable” (American Heart Association’s Scientific Sessions in Anaheim, California, November 13, 2001).
The study suggests less than 100 mg/dL is more appropriate, because once a meal is consumed, triglyceride levels rise.
Even when people have acceptable fasting triglyceride levels (the levels of triglyceride circulating in the blood after fasting overnight), after a high fat meal their triglyceride shoots up into levels that could put them at higher risk of heart disease.
If people can lower their baseline triglyceride levels with diet changes and exercise, their heart disease risk may drop throughout the day, even after high fat meals.
The study evaluated the implications of “desirable” fasting triglyceride in 50 healthy, non-obese men and women with normal cholesterol levels, whose average age was 35.
After their fasting triglyceride was measured, each volunteer was given a milkshake, standardized at 70 grams of fat per square meter of body surface. Their triglycerides after a milk shake were measured at intervals of two, four, six, eight and ten hours.
For volunteers with a fasting triglyceride between 101 and 149, the triglyceride level at the peak, four hours after consuming the shake, averaged 200 mg/dL, putting them at dangerously high levels, despite the acceptable fasting levels.
However, in volunteers with a fasting triglyceride of less than 100, the four-hour peak triglyceride after the milkshake was only 124 mg/dL on average.
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People with triglyceride levels at or above 100 were 50 percent more likely than those with lower levels to suffer from future heart attacks, need bypass surgery or angioplasty, or die from heart disease.
The average triglyceride level in the United States is 134 mg/dL and is considerably higher than triglyceride levels below 100 mg/dL commonly observed in countries where heart disease rates are low. .
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The higher triglyceride levels are associated with both increases in body weight and the disturbing increase in diabetes. It’s a two-sided problem, because people with high triglycerides often develop insulin resistance, a major factor in the most common type of diabetes. In some cases, high triglycerides are identified years before the onset of diabetes.
Triglyceride is a fat that always circulates in the blood, especially after a meal high in saturated fat. Enzymes normally break down these fat particles, but when the process is not working efficiently, triglycerides that are only partially broken down can cause fatty deposits in blood vessels, leading to atherosclerosis, also known as hardening of the arteries.
Triglycerides can increase the risk of blood clots, which combine with fatty deposits in the coronary vessels to cause heart attacks.
A combination of diet changes and exercise can reduce triglyceride levels by as much as 30 percent. These fats respond to regular exercise, weight loss, and a diet high in omega 3 fatty acids.
(The research supported by funding from the American Heart Association, the Veterans Affairs Medical Center and the National Institutes of Health).
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High Triglycerides Due to Anti-Retroviral (ARV) Drugs
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HIV-infected patients on high active anti-retroviral therapy (HAART), especially those receiving PI-containing HAART, have significantly increased blood triglyceride levels.
The anti-retroviral drugs have many detrimental effects on the metabolism. Besides sending triglyceride levels sky high, they increase:
- the blood levels of insulin, cholesterol, and low-density lipoprotein cholesterol (the bad cholesterol)
- the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL/HDL)
- the visceral adipose tissue area (fat in the waist, belly area), and
- the ratio of visceral adipose tissue to subcutaneous adipose tissue area.
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Highly Active Anti-Retroviral Therapy (HAART) is the name given to treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and progress of HIV disease.
The usual HAART regimen combines multiple (three or more) different anti-HIV drugs that are prescribed to many HIV-positive people, even before they develop symptoms of AIDS (and without considering that many will never develop these symptoms).
The HAART usually includes:
- one nucleoside analog (DNA chain terminator)
- one protease inhibitor (PI) and
- either a second nucleoside analog (“nuke”) or a non-nucleoside reverse transcription inhibitor (NNRTI).
These treatment regimens have been shown to reduce the amount of virus so that it becomes undetectable in a patient's blood.
The World Health Organization is orchestrating a global effort to get 3 million people onto anti-retroviral (ARV) drugs by the end of 2005.
Unfortunately, adherence to HAART is very difficult because of its toxicity and multiple side effects. Patients taking these three-drug “cocktails” can develop:
- various forms of anemia, sometimes irreversible (ARVs almost always include one or two nucleoside analogs, drugs like AZT that are notorious for their toxicity to red and white blood cells and blood cell production)
- bone loss
- cancer (quite commonly associated with the use of ARVs)
- heart disease (apparently related to the mechanism that also causes fat/triglyceride redistribution)
- serious or even fatal liver damage, or
- neurological (nervous system) damage.
Unfortunately, HIV stays with you. The HAART can suppress the virus and protect the immune system - but only if it’s taken on schedule, every day, for life. However, the concerns about HAART are very disturbing.
PLEASE NOTE: People with HIV/AIDS (PHAs) can develop high triglyceride (TG) levels in their blood - whether or not they are taking anti-HIV drugs. (The term PHA stands for Person With HIV/AIDS or People With HIV/AIDS, and refers to any person, at any stage living with HIV disease).
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Are You Stressed, Depressed?
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Prolonged stress is one of the main causes of elevated blood triglycerides.
A new study has found the evidence that psychological, mental stress causes triglycerides to stay in the bloodstream longer contributing to cardiovascular health problems (Psychophysiology, 2002: 39; 80-85).
The stress factor, however, has been repeatedly underestimated with regards to elevated blood lipids (fats).
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