Cholesterol and triglyceride tips
Some of the most basic measures of good health are blood cholesterol levels and triglyceride levels. Let’s look briefly at both, along with some information on what you can do to control each of them.

Cholesterol and triglycerides are both forms of lipids or fats and they are both necessary for life, in proper amounts. Cholesterol is necessary for making several essential hormones and for building cell membranes. Triglycerides (chains of high-energy fatty acids) provide a great deal of the energy needed for cell function.

These lipids come from two sources: dietary and endogenous (manufactured within the body). Dietary cholesterol and triglycerides primarily come from eating animal products and saturated fat. The dietary lipids are absorbed and are then delivered through the bloodstream to the liver for processing. The primary job of the liver is to make sure all tissues of the body receive the cholesterol and triglycerides they need to function. When possible (for about 8 hours after a meal), the liver takes dietary cholesterol and triglycerides from the bloodstream. But when dietary lipids are not available, the liver produces cholesterol and triglycerides on its own and packages them, along with certain proteins, into little spheres called lipoproteins. These are released into the bloodstream and delivered to the cells of the body; which remove cholesterol and triglycerides from the lipoproteins as needed.

Cholesterol basics
Desirable levels are below 200 mg/dL. Total cholesterol is considered to be at "borderline high risk" between 200 and 239, and "high risk" at levels above 240.

• LDL cholesterol: Optimal LDL levels are less than 100 mg/dL. Near optimal levels are between 100 and 129 mg/dL. Levels between 130 and 159 are "borderline high risk;" and levels between 160 and 189 are considered "high-risk;" levels of 190 and above are considered "very high risk."

• HDL cholesterol: HDL cholesterol levels below 41 mg/dL are considered too low.

What do LDL and HDL mean? LDL stands for “low density lipoprotein” and HDL stands for “high density lipoprotein.” In your bloodstream, “bad” cholesterol is carried by the LDL and “good” cholesterol is carried by the HDL. The total cholesterol level in your blood is a reflection of the balance between HDL and LDL cholesterol.

What can cause high cholesterol? Elevated cholesterol levels can be caused by several factors. They include diet, heredity, obesity, lack of exercise, age, and gender. Of these factors, only heredity, age and gender are beyond your control.

Why are high cholesterol levels bad? When LDL cholesterol is too high, it tends to stick to the lining of the blood vessels, leading to “atherosclerosis” or hardening of the arteries. Atherosclerotic “plaques” can cause narrowing of the arteries and lead to heart attacks and strokes. An elevated LDL cholesterol level is a major risk factor for heart disease and stroke.

Some people have elevated cholesterol levels as a result of some specific medical condition (diabetes, hypothyroidism, obstructive liver disease, chronic kidney failure), or drugs (anabolic steroids, progesterone drugs, and corticosteroids.) In these cases, treating the underlying problem often improves cholesterol levels.

Triglyceride basics
Triglycerides are often misunderstood. They are measured as part of a standard blood lipid profile, but often doctors don’t seem to know what to do if triglyceride levels are just a little elevated. While high triglyceride levels are associated with heart disease, no study has ever shown definitively that high triglyceride levels are independently a risk factor for heart disease.

Patients with elevated triglyceride levels nearly always have other risk factors for heart disease like obesity, diabetes, and/or high blood pressure. But it has not so far been possible to show that triglycerides themselves pose an independent risk for heart disease. The hardest association to sort out is that between triglycerides and HDL cholesterol. It seems that when triglycerides increase, HDL cholesterol decreases. So is the increased risk seen with the presence of high triglycerides due to the triglycerides themselves, or to the related reduction in “good” cholesterol? It is unknown. Recent evidence, however, strongly suggests that elevated triglyceride levels are a significant risk factor for cardiac disease.

What are good triglyceride levels? Normal triglyceride levels are less than 150 mg/dL. Borderline high levels are 150-199 mg/dl. High levels are 200 - 499 mg/dL and very high triglyceride levels are greater than 500 mg/dL. For people with triglyceride level problems, treatment should emphasize weight reduction and exercise. Drugs may be recommended for people with very high triglyceride levels.

Treatment basics for cholesterol and triglyceride problems
The primary method of treating both elevated cholesterol (and triglyceride) levels is with a combination of improved diet, exercise, and weight loss. Dietary changes should include lowering total fat, saturated fat, and dietary cholesterol. The diet should also include increased starch and fiber.

Physical activity should consist of at least 20 minutes of aerobic exercise three to five times per week. If that doesn’t seem possible, any increase in physical activity is helpful in bringing those levels down. Patients who are obese can often significantly reduce their LDL cholesterol and triglyceride levels by losing relatively modest amounts of weight.

Cholesterol and triglyceride levels should be re-measured 3-6 months after undertaking the initial control efforts. If lipid levels are still elevated, drug therapy may need to be considered.

Summary: Treatment of abnormal lipid levels can be summarized as follows: First, efforts at dietary changes, weight loss, and exercise should be tried. If these efforts fail to restore acceptable lipid levels, then most doctors will try a drug from one of the four classes of lipid-lowering drugs. Some experimentation with various medications may need to happen before a drug that does the best job for a particular person is found. 

---