Q. Recently a blood chemistry analysis showed my triglyceride level about 550 when it should be around 160. What does that mean?
A. We read and hear a great deal about the dangers of high blood cholesterol. Triglycerides, the other major blood fat, are not mentioned as often even though high blood levels can predispose people to heart attacks and can cause attacks of pancreatitis.
The general rule of thumb is that no treatment is needed when triglyceride levels in adults are less than 250 mg/dl. If triglycerides are between 250 and 500, treatment is aimed at preventing a heart attack and is recommended for those with
known coronary artery disease (CAD) or other major risk factors for CAD: These include cigarette smoking, high blood pressure, diabetes, extreme obesity (more than 35 percent overweight), a first degree relative (parent, brother or sister) who had a heart attack before the age of 55, evidence of narrowing of blood vessels to the legs or brain, or a low level of the "good" (HDL) cholesterol.
Vigorous treatment is required for you, and anyone else with a triglyceride level greater than 500, to prevent an attack of pancreatitis.
One reason for the increase in CAD in people with high triglycerides is an associated reduction in the level of HDL cholesterol, which may be raised by lowering triglycerides. High triglyceride levels impart a particularly high risk for CAD in women and in people with diabetes. Careful control of the blood sugar in diabetics will usually improve elevated levels of triglycerides, the most common lipid abnormality in diabetics.
Triglycerides can often be lowered by exercise and dietary measures. Weight loss is by far the most effective way for obese individuals to reduce their triglyceride levels. People with high triglycerides must severely limit their use of alcohol, which can raise triglycerides dramatically. Several effective medications are available if these dietary measures do not reduce triglycerides sufficiently.
Q. I have been trying to get my doctor to prescribe etidronate, which one of your prior columns described as a promising new drugfor the treatment of osteoporosis. Can you explain why he has been unable to do so?
A. Etidronate (didronel) has not been approved by the Food and Drug Administration (FDA) for use in the United States.
Although two studies concluded the drug was effective in preventing new fractures in individuals with post-menopausal osteoporosis, a third study actually showed an increase in the number of fractures in patients treated with etidronate compared with untreated patients. For this reason a committee of the FDA decided the drug needed further evaluation before it could be approved.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.