Fasting Blood Triglyceride Levels: Current Guidelines
The NCEP advises that adults have their blood lipids checked at least once every five years, starting at age 20. However, if you are over 40 you should get your triglycerides tested at least once a year. Diabetics must have their triglycerides measured every three (3) months.
In medicine, hypertriglyceridemia denotes high (hyper-) blood levels (-emia) of triglycerides. As a part of lipid management, it has become a major medical problem. This website is intended to allow you to become an informed patient who can manage your own care, ask the right questions, insist on adequate management and information, and seek an optimal outcome for yourself. Perhaps it will even help the health professionals who are giving care to better understand and, hopefully, incorporate into their practice the nutritional approach to high blood triglycerides.
Please note that this website is not intended for “most people”. It is written for those who want to stand out in self-health care. If you are such a person, we strongly advise that you give serious thought to all of the suggestions about how to improve you blood lipid profile, triglycerides in particular. If you are tempted to think the suggestions are too complicated or too simplistic, or biased, we assure you they are not.
In May, 2001, the U.S. National Cholesterol Education Program (NCEP), a division of the National Institutes of Health (NIH), released recommendations on who should be treated for elevated triglyceride levels.
The NCEP recommendations ("consensus statements") are the products of independent, non-Federal panels of experts and are based on the panels' assessments of medical knowledge available at the time the statements were made.
Therefore, they provide "snapshots in time" of the state of knowledge of the topics (new knowledge, however, is inevitably accumulating through medical research).
It should be noted, however, that the usually quoted "normal" blood lipid levels do change as they depend upon the levels found in the majority of the population as well as upon what... health officials decide is normal.
Therefore, the declared "normal" triglyceride levels -- that your doctor will use to tell you whether your various serum/blood levels are "normal" -- do NOT necessarily mean "healthy" levels.
Here is the American Cholesterol Education Program Expert Panel’s current policy on fasting blood triglyceride levels in adults:
less than 150 mg/dL (<1.7 mmol/L)
150 - 199 mg/dL (1.7–2.3 mmol/L)
200 - 499 mg/dL (2.3–5.64 mmol/L)
higher than 500 mg/dL (>5.64 mmol/L)
Here are the Canadian guidelines on fasting blood triglyceride levels in adults:
less than 2.0 mmol/L (<177.2 mg/dL)
2.0 - 2.5 mmol/L (177.2 - 221.5 mg/dL)
higher than 2.5 mmol/L (>221.5 mg/dL)
According to some European guidelines, blood triglyceride levels in adults should be categorized as follows:
less than 1.7 mmol/L (<150.1 mg/dL)
between 1.7 - 2.3 mmol/L (150.1 - 203.1 mg/dL)
- 2.3 mmol/L (151.1 - 203.1 mg/dL)
attention and intervention
2.3 - 4.6 mmol/L (203.1 - 407.1 mg/dL) with high LDL cholesterol (greater than 4.1 mmol/L, or 160 mg/dL)
Requiring aggressive treatment
The following "normal" blood triglyceride reference ranges are based on someone's age:
"Normal" Triglyceride Range
10 - 29
53 - 104 mg/dL, or 0.6 - 1.2 mmol/L
30 - 39
55 - 115 mg/dL, or 0.6 - 1.3 mmol/L
40 - 49
66 - 139 mg/dL, or 0.7 - 1.6 mmol/L
50 - 59
75 - 163 mg/dL, or 0.8 - 1.8 mmol/L
60 - 69
78 - 158 mg/dL, or 0.9 - 1.8 mmol/L
> 70 years
83 - 141 mg/dL, or 0.94 - 1.6 mmol/L
Here is another example of the "normal range" of blood triglycerides based on gender and age. Many health professionals find it quite accurate:
Keep in mind, these are only guidelines. The ranges were developed based on the entire population and may not apply to individuals.
PLEASE NOTE: Fasting values should be based on two serial measurements of serum (blood) triglycerides. Serial measurements are important because of intraindividual triglyceride variability which is 5 times that of cholesterol.
Healthy and Beneficial Blood Triglyceride Levels
As the "optimal" levels reflect health, the IDEAL (ie. beneficial) blood triglyceride levels for cardiovascular health seem to be the levels between 70 mg/dL and 100 mg/dL, or 0.8 - 1.1 mmol/L.
The average triglyceride level in the United States is 134 mg/dL, or 1.5 mmol/L and is considerably higher than triglyceride levels below 100 mg/dL, or 1.1 mmol/L commonly observed in countries where heart disease rates are low.
Although medical establishments consider blood triglyceride levels of 10 - 150 mg/dL, or 0.1 - 1.7 mmol/L normal, or good, according to many experts, desirable or favorable fasting blood triglyceride levels should be 50 - 150 milligrams per deciliter (mg/dL), or 0.6 - 1.7 millimoles per liter (mmol/L) of blood.
"Normal", however, does NOT necessarily mean "healthy" as it may include both healthy and many unhealthy people. We want "healthy", not just "normal" serum triglyceride (and other lipid) levels.
Therefore, in order to avoid future cardiovascular health problems, the "ideal" or beneficial (healthy) range of trigycerides should be much tighter than the often quoted "normal" triglyceride range referred to by your doctor, that is below 150 mg/dL, or 1.7 mmol/L.
This is important as elevations of the blood triglycerides, particularly in association with decreased HDL-"good" cholesterol, outside this range are the key marker for heart disease and stroke.
"Research shows that levels above 100 mg/dl significantly increase your risk for heart attack," says Bruce Holub, PhD, nutrition researcher at the University of Guelph in Ontario, Canada.
For each mmol/L increase in triglycerides - which translates into 88.5 mg/dL - the risk of coronary artery disease (CAD) increases by 37 percent in women and 14 percent in men.
All else being equal, a man with a triglyceride level of 300 mg/dL would have a risk of cardiovascular events roughly 28 percent higher than that of an otherwise comparable man who has a level of 100 mg/dL (a meta-analysis by John Hokanson and Melissa Austin, 1996).
Therefore, for every percentage your triglyceride level drops, so can your chance of heart disease or stroke.
True Baseline Triglyceride Measurement
The test for triglycerides - using a blood sample drawn from a vein or a fingertip - should be done after an overnight fasting when no extra triglycerides from a recent meal are present as they are being sent from the gut to body's fat tissue for storage. In practice, however, that way of obtaining a true baseline triglyceride measurement is often given no more than lip service.
As opposed to circulating HDL-"good" and LDL-"bad" cholesterol, triglyceride blood concentrations change significantly with food intake. Whenever you eat a meal that contains fat, your triglyceride levels rise. The degree of the increase depends on the baseline level.
If you have not been properly fasting when the blood sample was drawn, your physician may dismiss your elevated triglycerides reading as… insignificant
For example, if your triglyceride level is about 50 mg/dL, or 0.6 mmol/L after eating a classic fast-food "meal" of a hamburger, French fries, and milkshake, your triglycerides may increase by 15 percent to 20 percent.
In other words, the triglyceride level may rise to 70 mg/dL (0.8 mmol/L), 80 mg/dL (0.9 mmol/L), or perhaps 90 mg/dL (1.0 mmol/L) - but still will remain within the optimal range (below 100 mg/dL, or 1.1 mmol/L).
If your baseline triglyceride level is greater than 200 mg/dL, or 2.3 mmol/L
that high-fat junk "meal" could catapult your triglycerides to 300 mg/dL (3.4 mmol/L), 400 mg/dL (4.5 mmol/L), or even 500 mg/dL (5.6 mmol/L), and
this elevation may be prolonged for several hours beyond the normal eight-hour clearance period.
High Triglycerides: Stay Alert and Ask Questions
The most common cause of an elevated triglyceride level is a non-fasting specimen.
When it comes to health care, you need to stay alert, ask questions, and ultimately rely on yourself for important health care decisions.
By applying these guidelines, you will be able to take control of your health care, just as we all should do.
Unfortunately, your doctor may have you take the blood test without informing you of all factors that might affect the results.
You never know when even a “highly regarded” doctor might be rushed or inexperienced, or simply overly comfortable with a procedure, then end up taking a short cut at your expense, recommending a drug or an uncomfortable, invasive procedure based solely on a suspect or false test result.
The lesson: Always ask your doctor for specifics regarding factors that can create false positive or false negative test results.
Nothing, except water, is allowed from bedtime until you get your triglyceride bloodwork done next morning when a lab opens.
As far as a blood test determining triglyceride levels is concerned, for 12 to 14 hours before the test, only water (no coffee!) is permitted.
Overnight fasting is essential for an accurate measurement of blood triglycerides!
In addition, alcohol should not be consumed for the 24 hours just before the test.
You are also not supposed to take any vitamin supplements 24 hours prior to your fasting blood work. If you are currently on antihistamines, antibiotics or cortisone treatment only, you need to call the lab or your doctor for more information on how to proceed.
Anything taken in, other than water, during that time can elevate the blood triglycerides as they change dramatically in response to meals. Without the proper fasting, they can easily be high enough to prompt your doctor to prescribe drugs.
However, even fasting levels may vary considerably day to day. Therefore modest changes in fasting triglycerides measured on different days are not considered to be abnormal.
Tetimonial: "It Turned Out to Be a False Result"
My blood triglyceride level was alarmingly high 497 mg/dL (milligrams per deciliter of blood). (…)
It turned out to be a false result. A nurse sent to my home by my life insurance company had taken my blood sample just a few hours after I ate lunch.
For an accurate triglyceride reading, even more so than for an accurate blood cholesterol reading, it's important to fast for at least 12 hours before having blood drawn.
(…) a meal that is rich in fat is a meal that is rich in triglycerides, and it will cause a dramatic short-term spike in your blood triglyceride levels.
When my doctor drew my blood after an overnight fast during my annual physical a few months later, my triglyceride level was 97 [mg/dL].
Larry Lindner, Tufts University School of Nutrition Science & Policy.
Variability in Triglyceride Measurements
After a weekend of beer and pizza, Monday morning bloodwork readings tend to be higher than on the other days; therefore, take your weekend activities into account when having your test for blood triglycerides done.
Due to a lack of standardized measurement, however, variability in triglyceride measurements may occur. Daily concentrations of blood triglycerides vary more than the concentrations of most other metabolites and can be affected especially by:
previous alcohol (ethanol) consumption
other factors, such as some drugs and ascorbic acid/vitamin C (they can decrease triglyceride measurements).
Another factor that affects triglyceride measurement is postural change; the level can vary by as much as 15 percent, depending on whether your were standing or supine when the blood was drawn, because of associated shifts in plasma volume.
Yet another factor is laboratory variability, which can range between 5 percent and 10 percent on a daily basis.
Finally, intraindividual variability can be another 5 percent to 10 percent.
Those variations, however, will not matter as much in those who have an optimal baseline triglyceride value as they will in people who have an elevated value, in whom the variability will tend to be much more dramatic.
It should also be noted that test for blood (serum) triglycerides should not be performed on specimens collected between 24 hours and 8 weeks after myocardial infarction (heart attack), as levels will be lower than usual.
However, lipid profiles are best avoided following acute myocardial infarct, for up to 3 months, although cholesterol can be measured in the first 24 hours.
As a rule, variability in triglycerides measurement can be decreased if you are instructed to
fast overnight for at least twelve (12) hours
abstain from alcohol for two (2) days, and
consume two cups (473 mL) of water one (1) hour before the collection of blood.
In particular, the importance of the two-day abstinence from alcohol is based on significant alterations in the plasma fatty acid pattern that persist twenty-four (24) hours after the consumption of alcohol and elevations in triaglycerides observed as late as nine (9) hours after the consumption of alcohol with dinner. (
First, before having blood drawn for a triglyceride check, fast - preferably overnight - several (12-14) hours. Fasting is essential for triglycerides (it is not necessary to measure cholesterol though).
Second, have the blood test repeated to be sure your measurement is accurate. And ask your doctor for specifics regarding factors that can create false positive or false negative test results.
Third, tell your physician to also measure LDL and HDL cholesterol. A triglyceride measurement should be accompanied by a complete lipoprotein cholesterol determination.
Standard Fasting Lipid/Lipoprotein Profile
In assessing the risk of heart disease, standard medicine targets mainly total blood cholesterol levels and LDL-"bad" cholesterol. However, people with high cholesterol often have high triglycerides, especially when there is no another disorder present.
Therefore, the type of standard, conventional medical treatment used to lower cholesterol
depends on whether triglycerides are high or normal, and
is usually directed toward lowering both cholesterol AND triglycerides.
HERE ARE YOUR RESULTS
Check these various components in your fasting blood lipid profile.They are considered important indicators of your risk of having a heart disease. It is obviously best to be at the high end of the "good" HDL cholesterol range (> 80 mg/dL), and the low end of the "bad" LDL cholesterol (< 100 mg/dL) and triglycerides range (< 100 mg/dL is IDEAL).
SHOULD BE . . ..
Total Cholesterol (TC)
Under < 200 mg/dL
(Depending on your HDL)
200 mg/dL -239 mg/dL
240 mg/dL and Above
Under < 200 mg/dL (depending on your HDL level)
DESIRED: Not more than 4 times your HDL level.
Examples: 4 X 40 mg/dL HDL = 160 mg/dL total cholesterol (TC)
4 X 50 mg/dL HDL = 200 mg/dL total cholesterol (TC)
HDL Cholesterol (High Density Lipoprotein -"Good" Cholesterol)
Men - 65 mg/dL
Women - 75 mg/dL
Men - 60 mg/dL
Women - 65 mg/dL
Men - <55 mg/dL
Women - <60 mg/dL
Above > 60 - 70 mg/dL
The lower your HDL, the lower your total cholesterol (TC) should be!
HDL divided by Total Cholesterol (TC)
0.30 or Higher
Under < 0.24
Less than < 0.10
Above > 0.24
Example: 80 HD:190 TC = 0.42
The higher the number (HDL:TC ratio), the better - the lower your risk of heart attack.
150 mg/dL - 199 mg/dL
200 mg/dL - 499 mg/dL
Over >500 mg/dL
Under < 150 mg/dL
IDEAL: Under <100m/dL
When triglycerides are "severly high" (greater than < 1000 mg/dL), there is a risk of developing pancreatitis.
Triglycerides divided by HDL
2 or Less
MUCH TOO HIGH
Under < 2
110 TRG:60 HDL = < 2
The lower the number (TRG:HDL ratio), the better - the lower your risk of heart attack.
LDL Cholesterol (Low Density Lipoprotein - "Bad" Cholesterol)
NEAR OPTIMAL OR ABOVE OPTIMAL
100 mg/dL - 129 mg/dL
130 mg/dL - 159 mg/dL
160 mg/dL - 189 mg/dL
OPTIMAL: Under < 100 mg/dL
VERY HIGH: 190 mg/dL and above
LDL Cholesterol FOR HEART PATIENTS
MUST BE UNDER
< 80 mg/dL
The lower, the better
IDEAL: Under < 70 mg/dL
(If you are a heart patient, LDL MUST be under < 70 mg/dL) SEE YOUR DOCTOR, IF
NOT UNDER < 80 mg/dL.
6-Hour Fasting Blood Sugar
Under < 87 mg/dL
110 - 125 mg/dL
126 mg/dL and Above (Pre-diabetes)
Under < 90 SEE YOUR DOCTOR, if 110 mg/dL or above
8-Hour Fasting Blood Insulin
Below 5 uU/ml (VERY GOOD: 2 - 3 uU/ml
5 - 15 uU/ml
Over 15 uU/ml
Under < 90 SEE YOUR DOCTOR, if over 10 uU/ml
PLEASE NOTE: These numbers are based on a fasting lipid profile: 12 to 14 hours before the test (alcohol should NOT be consumed for the 24 hours). IF YOU DON'T FAST, your Triglycerides, LDL, Glucose and Insulin will be higher.
Triglycerides: Measurement Units: Mg/dL Vs. Mmol/L
American blood laboratories use a different version of the metric system than does most of the rest of the world, which uses the SI or Systeme Internationale d’Units.
The SI is an international standard recognized around the world – except by the United States of America, Liberia, and Myanmar (Burma) who will probably adopt it in due time.
In some cases translation between the two systems is easy, but the difference between the two is most pronounced in the measurement of chemical concentration.
The American System: mg/dL
The American system generally uses mass per unit volume (milligrams per deciliter of blood). By considering the weight of a substance in the blood, it is less accurate.
The term "mg/dL" then is the abbreviation for milligrams (mg) per deciliter (dL) and describes how much lipid is present in a specific amount of blood.
Greek and Latin words form the prefixes for the units on most lab tests. A milligram is a thousandth (1/1000) of a gram (a gram is about the weight of a paper clip).
A deciliter is one tenth (1/10) of a liter (a liter being just over a quart) or about 1/4 of a pint.
The SI System: mmol/L
The SI system (Systeme Internationale) - in Canada, Australia, Europe, and other countries - uses moles per unit volume (millimoles per liter of blood). By considering the number of molecules of a substance in the blood, it is more accurate then.
The term "mmol/L" is the abbreviation for millimoles (mmol) per liter/litre (L) and describes how much lipid is present in a specific amount of blood.
A millimole is 1/1,000 of a mole. A mole is an amount of a substance (in this case, triglyceride or cholesterol) that contains a certain number of molecules or atoms.
Since mass per mole varies with the molecular weight of the substance being analyzed, conversion between the American and SI units requires many different conversion factors.
from mg/dL to mmol/L:
multiply by (x) 0.01129
from mmol/L to mg/dL: multiply by (x) 88.6
from mg/dL to mmol/L:
multiply by (x) 0.02586
mmol/L to mg/dL: multiply by (x) 38.7.
Glucose (GLU) Conversion:
For diabetics wishing to converse in American sugar lingo, the conversion is 18. For example, a blood sugar reading of 7.5 mmol/L multiplied by 18 yields 135 mg/dL.
If you are a Canadian snowbird heading south who may feel shut out in the poolside medical exchange, this may help.
To convert your cholesterol into Floridian, simply multiply the value by 39. For example, if your cholesterol comes in at 5.2 mmol/L, multiplying this by 39 yields a value 202 mg/dL.
The same conversion factor of 39 applies to HDL and LDL values.
However, your triglyceride values must be multiplied by 89.
Armed with these simple conversion factors you can impress your American neighbours with your bilingual knowledge of lab values, and then exchange stories of how to amazingly improve the numbers without actually following your doctor’s advice.
Triglyceride Conversion Calculator
Enter the Triglyceride level in the spaces provided below and then click the "Calculate" button to convert. Use the "tab" key to move from cell to cell for faster input.
Please treat the results with due care and consideration.
Physical Symptoms of High Triglycerides
A close-up of an eruptive xanthoma on the back of a man with a triglyceride level of 4600 mg/dL, or 51.9 mmol/L and acute pancreatitis.
Most people with borderline-high (150 - 199 mg/dL, or 1.7–2.3 mmol/L) or high triglycerides (200 - 499 mg/dL, or 2.3–5.6 mmol/L) will not have any symptoms. That's what makes it so scary. Because no one feels badly with high triglycerides, a lot of people simply have no clue!
Even in people with severe blood triglycerides - 1000 mg/dL, or 11.3 mmol/L, or acutely and massively elevated triglycerides - results from the physical examination are variable, ranging from normal examination results to one or more of the following findings:
When sustained elevated triglycerides are well above 1000 mg/dL sometimes eruptive xanthomas are found. These are 1- to 3-mm pin-head yellow papules, or bumps on an erythematous base occurring mostly on the back, buttocks, chest, bony elbows, knees and heels.
The lesions are caused by accumulations of chylomicrons and will disappear gradually when triglycerides are kept below 1000 mg/dL. If the diagnosis of eruptive xanthomas, a benign condition, is in doubt, obtaining a biopsy of the suspicious lesions will reveal accumulations of fat (not cholesterol).
Adults with dysbetalipoproteinemia (type III) - a rare lipid disorder with high levels of blood triglycerides (greater than 400 mg/dL or even 1000 mg/dL) and cholesterol - may have palmar xanthomas (yellowish creases of the palms). This type of xanthoma is considered characteristic of this disorder. Tuberous or tuberoeruptive xanthomas, which also may occur in other hyperlipidemias, may arise on the elbows, knees, or buttocks.
The mid epigastric area or upper right or left quadrants will be tender to palpation, if pancreatitis or the chylomicronemia syndrome is present. Also in people with the chylomicronemia syndrome, memory loss, dementia, and depression have been reported.
Triglyceride levels of 4000 mg/dL or higher, or >45.2 mmol/L may cause a condition known as lipemia retinalis, in which eye examination reveals retinal blood vessels (and occasionally the retina) that have a pale pink, milky appearance.
It should be noted that fairly common on the eyelids, xanthomas - yellow, soft and slightly raised non-contagious bumps made of cholesterol deposits - are also a sign of elevated cholesterol levels.
In all people, eruptive xanthomas are a sign of severely evelvated blood triglyceride levels.
Classification of Cholesterol Levels
Here is the American Cholesterol Education Program (NCEP) Expert Panel’s current policy on total cholesterol blood levels in adults:
less than 200 mg/dL (less than 5.2 mmol/L) is considered desirable
240 mg/dL and above (>6.2 mmol/L and higher) is considered high.
The NCEP is a division of the National Institutes of Health (NIH). Its recommendations ("consensus statements") are the products of independent, non-Federal panels of experts and are based on the panels' assessments of medical knowledge available at the time the statements were made.
Therefore, they provide "snapshots in time" of the state of knowledge of the topics (new knowledge, however, is inevitably accumulating through medical research).
It should be noted, however, that the usually quoted "normal" blood lipid levels do change as they depend
upon the levels found in the majority of the population as well as
upon what... health officials decide is normal.
The Cholesterol Fractions: LDL & HDL
Although total serum cholesterol doesn't correlate with cardiovascular disease in the range of 180 to 240, certain fractions of that total cholesterol do correlate.
These fractions are HDL-"good" (high density) and LDL-"bad" (low density) cholesterol. This is why you need a Lipid Profile, also called a Lipid Panel, and not just a total cholesterol when you get your blood drawn.
LDL carries cholesterol for cell building needs, but leaves behind any excess on artery walls and in tissues;
HDL helps to prevent narrowing of the artery walls by removing the excess cholesterol and transporting it to the liver for excretion.
For this reason, their blood levels are important markers for cardiovascular health and disease.
LDL-"bad" cholesterol level:
less than 100 mg/dL (less than 2.6 mmol/L) is considered optimal
100 mg/dL - 129 mg/dL (2.6 mmol/L - 3.4 mmol/L) - near optimal or above optimal
below 40 mg/dL (1.0 mmol/L) is considered low (it increases the risk for coronary artery disease in people who also have high total cholesterol levels).
Low levels of HDL-"good" cholesterol are associated with an increased risk of congnitive impairment and dementia - a chronic or persistent deterioration of intellectual function and cognitive skills.
Symptoms of dementia include memory loss, personality changes, lack of interest in personal care, impaired reasoning ability and disorientation. As cardiovascular disease and stroke are important risk factors for dementia, the optimal levels of HDL cholesterol may help to prevent dementia. (Van Exel, E., et al. Association between high-density lipoprotein and cognitive impairment in the oldest old. Annals of Neurology.Vol. 51, Issue 6, June 2002:716-721).
However, according to Robert H. Eckel, professor of medicine at the University of Colorado Health Sciences Center, not all HDL is created equal. Just as we once thought all cholesterol was bad, there is now evidence that some "good" HDL may not be good after all (HDL particles are heterogeneous and multiple subclasses differing in diameter and density have been identified).
The Desired Cholesterol Ratios
The published evidence is quite clear in documenting that the actual total cholesterol level itself is not the most important risk factor of cardiovascular disease.
It is the ratio between the level of HDL-"good" cholesterol and total cholesterol.
Therefore, in adults, the HDL-"good" cholesterol/total cholesterol ratio should be higher than 0.24 (just divide your HDL level by your cholesterol).
Or more precisely, the HDL/total cholesterol ratio:
0.24 or higher is considered ideal
under 0.24 - low
less than 0.10 - very dangerous.
Generally speaking, the higher the ratio, the better (the lower your risk of a heart attack).
However, HDL is closely related to triglycerides. It appears common for people with high triglycerides to have low HDL’s, and these same people also tend to have high levels of clotting factors in their blood stream, which is unhealthy in protecting against heart disease.
Therefore, in adults, the triglyceride/HDL-"good" cholesterol ratio should be below 2 (just divide your triglycerides level by your HDL).
Or more precisely, the triglyceride/HDL ratio:
2 or less is considered ideal
4 - high
6 - much too high.
And, since HDL (high density lipoprotein) is protective against heart disease, the lower the ratio, the better. In other words, the lower your triglycerides, or the higher your HDL, the smaller this ratio becomes.
It is now believed that the triglycerides/HDL ratio is one of the most potent predictors of heart disease. A Harvard-lead study author reported:
"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)."
However, association between triglycerides and HDL cholesterol is the most difficult to sort out. It turns out that whenever triglycerides are increased, HDL cholesterol decreases.
So is the increased risk seen with high triglycerides due to the triglycerides themselves, or to the associated reduction in HDL-“good” cholesterol and increase in LDL-“bad” cholesterol. So far, nobody can say for sure.
However, according to Robert H. Eckel, professor of medicine at the University of Colorado Health Sciences Center, there is some evidence indicating that not all HDL is created equal. Just as we once thought all cholesterol was bad, there is now evidence that some "good" HDL may not be good after all.