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Diet and exercise key for treating high triglycerides: New AHA statement
 
 
  April 19, 2011 | Michael O'Riordan
www.theheart.org
 
Baltimore, MD - Diet and exercise are the cornerstone of treatment for patients with elevated triglyceride levels, according to a new scientific statement from the American Heart Association (AHA) [1]. Based on an algorithm for screening and managing patients with elevated triglycerides, experts have established an optimal level of nonfasting triglycerides, that being less than 100 mg/dL, and recommend intensive diet and lifestyle changes for patients with borderline elevated triglycerides.
 
"This is the wonderful part of this whole process," Dr Michael Miller (University of Maryland, Baltimore), the chair of the writing committee, told heartwire. "We can make a major dent with lifestyle therapy, and that includes the traditional lifestyle measures, although we might have to be a little bit more rigorous in terms of diet and exercise in patients with elevated triglycerides."
 
For patients with borderline triglyceride levels, those ranging from 150 to 199 mg/dL, experts recommend losing 5% of current body weight and limiting carbohydrates to 50% to 60% of daily caloric intake. Weight loss, noted Miller, has a beneficial effect on lipids and lipoproteins, with a 5% to 10% weight reduction resulting in a 20% decrease in triglycerides, an approximate 15% reduction in LDL cholesterol, and an 8% to 10% increase in HDL cholesterol. The AHA writing committee recommends limiting added sugars to less than 10% of daily caloric intake and provides new guidance on fructose consumption, recommending that borderline patients consume less than 100 grams.
 
The statement is published online April 18, 2011 in Circulation.
 
The confusion with triglycerides
 
To heartwire, Miller said there has been some confusion surrounding the role of triglycerides in cardiovascular disease, with experts questioning whether it was a predictor of cardiovascular events, in and of itself, and how much elevated triglyceride levels could be influenced by diet and lifestyle.
 
"We've known that triglycerides are linked with LDL cholesterol in that high levels of both confer a greater risk than either one alone," said Miller. "In fact, having a high triglyceride level, above 200 mg/dL, with elevated LDL cholesterol confers about a twofold risk of heart disease. The question is how you tease out triglycerides from other risk factors, because typically people who have high triglycerides often have insulin resistance, low HDL cholesterol, and high blood pressure."
 
Miller noted that studies have shown that accounting for these various factors of the metabolic syndrome makes it harder to tease out the relative risks of elevated triglyceride levels. Multivariate analysis accounting for these other risk factors diminishes the relative importance of triglycerides, but elevated levels remain an important independent predictor of cardiovascular risk, he said.
 
In the new AHA statement, the writing committee, including vice chair Dr Neil Stone (Northwestern University, Chicago, IL), base their recommendations on an analysis of more than 500 international studies over the past 30 years. The group defines normal nonfasting triglyceride levels as <150 mg/dL and optimal as <100 mg/dL. Among individuals with borderline, high, and very high triglyceride levels, weight loss of up to 10% of body weight is recommended.
 
Dietary recommendations based on triglyceride levels
 

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The group also makes new recommendations on fructose consumption and states that individuals should eat no more than 50 to 100 g of fructose from processed and naturally occurring foods. Individuals are encouraged to eat more vegetables and fruits lower in fructose, such as cantaloupe, grapefruit, strawberries, peaches, and bananas. In addition, individuals should eat high-fiber whole grains and healthier unsaturated fats, especially omega-3 fatty acids.
 
All individuals are encouraged to exercise at moderate intensity for at least 150 minutes per week, as these activities can reduce triglyceride levels a further 20% to 30%.
 
Miller noted that in patients with high triglyceride levels, non-HDL-cholesterol levels, in accordance with the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) guidelines, are used to guide drug therapy. For those with very high triglyceride levels, drug therapy is used to reduce the risk of pancreatitis.
 
Of note, the guidelines suggest using nonfasting triglyceride levels, which should simplify things for patients and clinicians by doing away with the traditional 12-hour fast. The paper notes that in the US, 31% of adults have triglyceride levels that exceed 150 mg/dL and that Mexican Americans (36%) are more likely than whites (33%) and blacks (16%) to have high triglycerides.
 
1. Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease. Circulation 2011; DOI: 10.1161/CIR.0b013c3182160726. Available at: http://circ.ahajournals.org.
 
 
 
 
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