Triglycerides Level: 304.....Should I panic?

[Medical Lab Guy]

Originally Posted by JG183

The 3 most important factors of cholesterol testing:

1) The ratio of triglycerides to HDL-cholesterol is what shows strongest association with the extent of coronary disease.

- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/

2) Having triglycerides under 100 is correlated with "Pattern A" LDL particle size (the healthier pattern), which also often lead to high measured LDL.

- http://www.ncbi.nlm.nih.gov/pubmed/1420088

3) In patients with low serum triglyceride and undesirably high total cholesterol levels, Friedewald's equation may overestimate LDL.

- http://www.ncbi.nlm.nih.gov/pubmed/18426324

Friedewald equation:
Total – (HDL + [Trigs/5]) = LDL

There is a newer equation, called the Iranian Equation, that does a better job of calculating LDL when trigs are below 100. That equation is:

(Total/1.19) + (Trig/1.9) – (HDL/1.1) -38 = LDL

There's a bias introduced by the use of any equation. It is commonly understood that the equation doesn't work well with very high or low triglycerides as far as estimating VLDL. The first lipids that were actually measured were total cholesterol and HDL cholesterol. A direct measurement for VLDL is still elusive and so calculations are introduced. The intent were to get an LDL value.

We are now able to directly measure LDL and don't need the equation based on present technology. The problem still persists based on technology bias. The original work was performed using differential gradient ultracentrifugation. This is a resarch tool that nobody uses for clinical practice. Todays measurements introduce method bias values that may not at times correlate with the original gold standard method. All fraciions were directly measured including VLDL as opposed to todays methods that are still unable to directly measure VLDL.

So today we have the option of ordering a lipid panel that can involve a calculated LDL-C or a lipid panel with a directly measured LDL-D. When one compares a LDL-D to LDL-C one finds a negative bias in LDL-C that has lower LDL values. When triglycerides are over 400 mg/dl the Friedwald equation is invalid and no value can be reported or obtained for LDL-C so that won't work and there is no workaround except to use a method the directly measure the LDL. Other studies have also shown diseases like diabetes or other dyslipidemic states are better off with a directly measured LDL. Those conditions alter the VLDL ratio of triglycerides conatined in cholesterol fractions. Others argue that the calculated values rather than the measured LDL values correlate better clinically and to the original method.

It is still up in the air as to which method is better ie which correlates better clinically or which correlates better to the original method.

[Williepaws]

Originally Posted by CarnivalGal

Best ways to lower triglycerides are (per the Mayo Clinic):

- Avoiding sugar and refined carbs (the mainstays of the fast food you're eating)
- Exercise regularly
- Lose weight if overweight (should happen as a side effect of doing the other things listed)
- Choose healthier fats, like those found in vegetables (olive oil, avocado oil, etc)
- Limit alcohol consumption

many people with very high triglycerides dont drink, dont eat red meat, eat lots of veggies and fruit, dont eat fried foods or consume much sugar. etc etc. One size does not fit all. I wish drs and clinics could understand that concept.