Triglyceride levels

Discuss cholesterol, HDL, LDL, and triglyceride levels and how they contribute to the development of heart disease. 

HDL cholesterol protects against heart disease so the higher the numbers the better. An HDL level less than 40 mg dL is low and considered a major risk factor for heart disease Triglyceride levels Hiat are borderline (150-190 mg dL) or high (above 190 mg dL) may need treatment in some individuals. 

While the fibric acid derivatives have antihyperlipidemic effects, their use varies depending on the drug. For example, Clofibrate (Atromid-S) and gemfibrozil (Lopid) are used to treat individuals with very high serum triglyceride levels who present a risk of abdominal pain and pancreatitis and who do not experience a response to diet modifications. Clofibrate is not used for the treatment of other types of hyperlipidemia and is not thought to be effective for prevention of coronary heart disease. Fenofibrate (Tricor) is used as adjunctive treatment for the reduction of LDL, total cholesterol, and triglycerides in patients with hyperlipidemia. 

Niacin is used as adjunctive therapy for the treatment of very high serum triglyceride levels in patients who present a risk of pancreatitis (inflammation of the pancreas) and who do not experience an adequate response to dietary control. 

In many individuals, hyperlipidemia has no symptoms and the disorder is not discovered until laboratory tests reveal elevated cholesterol and triglyceride levels, elevated LDL levels, and decreased HDL levels. Often, these drags are initially prescribed on an outpatient basis, but initial administration may occur in the hospitalized patient. Seram cholesterol levels (ie, a lipid profile) and liver functions tests are obtained before the drugs are administered. 

The patient will usually take these drugs on an outpatient basis and come to the clinic or the primary health care provider s office for periodic monitoring. Frequent monitoring of blood cholesterol and triglyceride levels is done as a part of the ongoing assessment. 

Educating the Patient and Family The nurse stresses the importance of following the diet recommended by the primary health care provider because drug dierapy alone will not significandy lower cholesterol and triglyceride levels. The nurse provides a copy of the recommended diet and reviews the contents of the diet with the patient and family. If necessary, the... 

Monitor serum triglyceride levels with prolonged infusions... 

A fibrate derivative or niacin should be considered in select patients with a low high-density lipoprotein (HDL) cholesterol less than 40 mg/dL (1.04 mmol/L) and/or a high triglyceride level greater than 200 mg/dL (2.26 mmol/L). In a large randomized trial in men with established CAD and low levels of HDL cholesterol, the use of gemfibrozil (600 mg twice daily) significantly decreased the risk of non-fatal myocardial infarction or death from coronary causes.78... 

The predominant effects of fibrates are a decrease in triglyceride levels by 20% to 50% and an increase in HDL cholesterol levels by 9% to 30% (Table 9-8). The effect on LDL cholesterol is less predictable. In patients with high triglycerides, however, LDL cholesterol may increase. Fibrates increase the size and reduce the density of LDL particles much like niacin. 

A statin combined with a resin results in similar reductions in LDL cholesterol as those seen with ezetimibe. However, the magnitude of triglyceride reduction is less with a resin compared to ezetimibe, and this should be considered in patients with higher baseline triglyceride levels. In addition, gastrointestinal adverse events and potential drug interactions limit the utility of this combination. 

High-density lipoprotein (HDL) less than 35 mg/dL (0.91 mmol/L) and/or a triglyceride level greater than 250 mg/dL (2.83 mmol/L)... 

To identify further which substance, cafestol or kahweol, or both, was inducing changes in serum cholesterol, the investigators attempted, but failed due to technical limitations, to separate the two chemical compounds. Alternatively, they compared coffee oil from Arabica vs. Robusta coffee beans. Arabica beans contain both cafestol and kahweol, while Robusta beans contain cafestol, but almost no kahweol. The investigators found that Arabica and Robusta oils both increased serum cholesterol and triglyceride levels comparably. They thus concluded that cafestol is, and kahweol might be, a serum cholesterol raising factor. 

Tibric acid (10), interestingly, has the m-carboxysulfonamido functionality but its activity is expressed, instead, as suppression of serum triglyceride levels. In its reported preparation, chloro-sulfonic acid treatment converts 2-chlorobenzoic acid to chlorosulfonate 9, which readily forms the hypolipidemic agent tibric acid (10) on reaction with... 

A fibrate derivative or niacin should be considered in selected patients with a low high-density lipoprotein (HDL) cholesterol (<40 mg/dL) and/ or a high triglyceride level (>200 mg/dL). 

Nicotinamide should not be used in the treatment of hyperlipidemia because it does not effectively lower cholesterol or triglyceride levels. 

Increases in serum lipids and glucose appear to be transient and of little clinical importance. /J- Blockers increase serum triglyceride levels and decrease high-density lipoprotein cholesterol levels slightly. /1-Blockers with -blocking properties (carvedilol and labetalol) do not affect serum lipid concentrations. 

Because of the similarity, it is difficult to conclude whether the lipid changes induced by SERMs offer any advantage over the profile determined by HT. Triglyceride levels have been proposed as an independent risk factor for CVD in postmenopausal women (Miller 1998). Further, there are some indications that increases in triglycerides may favor the reduction in the size of LDL particles. Smaller LDL particles are more susceptible to oxidation and have been associated with a higher risk potential (Austin et al. 1988), but whether this observation confers any clinical prejudice to hypertriglyceridemia has not been proven at present. 

In the studies discussed, wheat bran, cellulose, and psyllium fiber feeding resulted in increased fecal fat losses and in lowered blood serum cholesterol and triglyceride levels (14,15,32,41) as well as increased fecal losses of calcium. Possible involvement of dietary fat with high or low dietary fiber intake has not been extensively investigated. However, that calcium is involved in intestinal fat absorption is generally accepted (42-45). 

Dibromoethane is considered to be a weak hepatotoxin in animals. Hepatocellular fatty change (degeneration) is one of the common lesions in experimental animals associated with acute oral exposure to 1,2-dibromoethane (Botti et al. 1986). When administered to rats by gavage at a dosage of 110 mg/kg/day, this lesion is corroborated by an increase in liver triglyceride levels that begins within 8 hours of treatment (Nachtomi and Alumot 1972). 

A patient with a history of recurring attacks of pancieathis, eruptive xanthomas, and increased plasma triglyceride levels (2000 mg/dL) associated with chylomicrons, most likely has a deficiency in... 

The statins have been demonstrated to markedly lower plasma LDL levels (and triglyceride levels to a lesser extent). In fact, statins were approved by the US FDA on the basis of a surrogate endpoint reduction in plasma cholesterol levels. Since we know that increased plasma cholesterol levels are correlated with increased risk of coronary artery disease, it seems logical that reducing plasma cholesterol levels would lead to reduced risk. That turns out to be true in this case. However, see the case of hormone replacement therapy (HRT) for women for a more complex example, discussed below. 

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