The first step to taking charge of high triglycerides is understanding your numbers. Here’s how triglyceride levels are categorized, according to the U.S. National Library of Medicine:
Less than 150 milligrams per deciliter (mg/dL) is normal150 to 199 mg/dL is borderline high200 to 499 mg/dL is high500 and over is very high
High triglycerides means that there is a high number of fat particles floating in your bloodstream or stored in fat cells. Your body needs triglycerides for energy, but excess levels, especially when accompanied by high low-density lipoprotein (LDL, or “bad”) cholesterol and low high-density lipoprotein (HDL, or “good”) cholesterol can play a role in fat accumulation in artery walls, notes the American Heart Association (AHA). This fatty buildup is called atherosclerosis, and it narrows the arteries and makes them less flexible for blood to freely flow through. Plaques can also rupture and lead to blood clots, which can cause a heart attack or stroke. Severely high triglyceride levels can do damage to the pancreas and even cause skin disorders.
Atherosclerosis
As mentioned, atherosclerosis refers to a buildup of plaque in the arteries that can eventually lead to more serious heart problems. Experts have known for years that LDL cholesterol plays a major role in plaque buildup. What wasn’t as clearly understood in the past was the role that triglycerides play in this process, but increasingly, there is evidence that triglycerides are an independent factor in inflammation, atherosclerosis, and mortality from all causes, according to a paper published in February 2016 in the journal Circulation Research. A review published in November 2018 in the journal Nutrients came to the same conclusion: Triglyceride-rich lipoproteins are associated with the plaque buildup that occurs during atherosclerosis.
Coronary Artery Disease
When plaque is allowed to build up over time in the heart vessels, the condition that results is known as coronary artery disease (CAD), which restricts blood flow to the heart and other vital organs. The plaque also makes it more likely for a blood clot to form and further block the artery. A number of dangerous and potentially life-threatening conditions can result from CAD. The restriction of blood flow can ultimately lead to a heart attack or angina. Other possibilities include heart failure and arrhythmia. That said, severely elevated triglyceride levels are an entirely different animal. “Once you get above 1,000 mg/dL, the more likely it is that you have a more severe genetic predisposition [to high triglycerides],” says Douglas Jacoby, MD, a cardiologist with Penn Medicine in Philadelphia. In these cases, the triglyceride particles are not risk factors for heart disease only but are a risk for pancreatitis, he says. (More on that below.)
Pancreatitis
This is why knowing your triglyceride number is so important: The reading can clue you in to your specific health risks. “If you have very high triglycerides, your biggest risk is pancreatitis,” says Suzanne Steinbaum, MD, a holistic cardiologist in clinical practice in New York City. “The high triglyceride levels overtax the pancreas and inhibit its function.” Pancreatitis is a very painful, sometimes life-threatening condition that affects the pancreas gland. The pain is often caused by gallstones passing through the common bile duct. Researchers estimate that up to 10 percent of cases of acute pancreatitis are caused by high triglycerides, according to an article published in June 2018 in the United European Gastroenterology Journal. In addition, acute pancreatitis during pregnancy, while rare, is a dangerous condition that can lead to serious, even fatal complications for mom and baby, according to a case report published in May 2019 in the Clinical Journal of Obstetrics and Gynecology. To cause pancreatitis, triglyceride levels have to be very high, typically above 1,000 mg/dL, but risk increases once you pass 500 mg/dL, according to 2018 guidelines from the AHA and American College of Cardiology. At these levels, the triglycerides seem to cause damage when they are broken down by enzymes in the pancreas. Your doctor can help you manage this risk.
Skin Disorders
When triglyceride levels are very high, they can also result in an uncomfortable skin condition known as eruptive xanthomatosis, says Akshay Khandelwal, MD, an interventional cardiologist at Henry Ford Medical Center in Detroit, Michigan. This looks like a bumpy, pea-sized rash that is yellow, orange, or red in color and surrounded by a halo, according to the U.S. National Library of Medicine. The rash often appears on the buttocks or around the shoulders, arms, thighs, or legs. Eruptive xanthomatosis is rare and typically related to triglyceride levels higher than 2,000 mg/dL, according to a case study and review published in January–February 2018 in the Journal of Family Medicine and Primary Care. Over time, elevated levels of triglycerides, just like high cholesterol, can lead to serious health problems. If you’ve been diagnosed with hypertriglyceridemia, be sure to talk with your doctor about ways to reduce and control your triglycerides. With the right lifestyle changes, including a healthy diet and regular exercise — and, if needed, medications — you can get your triglycerides down to a healthier level and reduce your risk of health conditions related to hypertriglyceridemia. Additional reporting by Jessica Migala.
