Triglycerides

Blood tests for triglycerides are usually part of a lipid profile that is used to help identify an individual’s risk of developing heart disease and to help make decisions about what treatment may be needed if there is borderline or high risk. As part of a lipid profile, it may be used to monitor people who have risk factors for heart disease, those who have had a heart attack, or those who are being treated for high lipid and/or high triglyceride levels.

Results of the cholesterol test and other components of the lipid profile are used along with other known risk factors of heart disease to develop a plan of treatment and follow-up. Treatment options may include lifestyle changes, such as diet or exercise programs, or lipid-lowering drugs, such as statins.

Adults

A lipid profile, which includes triglycerides, is recommended every 4 to 6 years to evaluate risk of heart disease in healthy adults. Children should have a lipid profile screening at least once between the ages of 9 and 11 and once again between the ages of 17 and 21.

Testing may be ordered more frequently when people have identified risk factors for heart disease. Some risk factors for heart disease include:

• Cigarette smoking
• Being overweight or obese
• Unhealthy diet
• Being physically inactive—not getting enough exercise
• Age (men 45 years or older or women 55 years or older)
• High blood pressure (hypertension—blood pressure of 140/90 or higher or taking high blood pressure medication)
• Family history of premature heart disease (heart disease in an immediate family member—male relative under age 55 or female relative under age 65)
• Pre-existing heart disease or already having had a heart attack
• Diabetes or prediabetes

For diabetics, it is especially important to have triglycerides measured as part of any lipid testing since triglycerides increase significantly when blood glucose levels are not well-controlled.

Youth

Screening for high cholesterol as part of a lipid profile is recommended for children and young adults. They should be tested once between the ages of 9 and 11 and then again between the ages of 17 and 21. Earlier and more frequent screening with a lipid profile is recommended for children and youths who are at an increased risk of developing heart disease as adults. Some of the risk factors are similar to those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight.

High-risk children should have their first cholesterol test between 2 and 8 years old, according to the American Academy of Pediatrics. Children younger than 2 years old are too young to be tested.

Monitoring

As part of a lipid profile, triglycerides tests may be ordered at regular intervals to evaluate the success of lipid-lowering lifestyle changes, such as diet and exercise, or to determine the effectiveness of drug therapy such as statins. Guidelines from the American College of Cardiology and the American Heart Association recommend that adults taking statins have a fasting lipid profile done 4 to 12 weeks after starting therapy and then every 3 to 12 months thereafter to assure that the drug is working.

In general, healthy lipid levels help to maintain a healthy heart and lower the risk of heart attack or stroke. A healthcare practitioner will take into consideration the results of each component of the lipid profile as well as other risk factors to help determine a person’s overall risk of heart disease, whether treatment is necessary and, if so, which treatment will best help to lower the person’s risk.

In 2002, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) provided the guidelines for evaluating lipid levels and determining treatment. In 2013, the American College of Cardiology and the American Heart Association issued guidelines for adults that made recommendations on who should receive cholesterol-lowing therapy. (For more details, see the Lipid Profile article).

However, use of the updated guidelines remains controversial. Many still use the older guidelines from the NCEP ATP III to evaluate lipid levels and cardiovascular disease risk:

For adults, triglyceride test results are categorized as follows:

• Desirable: Less than 150 mg/dL (1.7 mmol/L)
• Borderline high: 150 to 199 mg/dL (1.7-2.2 mmol/L)
• High: 200 to 499 mg/dL (2.3-5.6 mmol/L)
• Very high: Greater than 500 mg/dL (5.6 mmol/L)

For children, teens and young adults:

From newborn to age 9

• Acceptable: Less than 75 mg/dL (0.85 mmol/L)
• Borderline high: 75-99 mg/dL (0.85-1.12 mmol/L)
• High: Greater than 100 mg/dL (1.13 mmol/L)

For ages 10-19 years

• Acceptable: Less than 90 mg/dL (1.02 mmol/L)
• Borderline high: 90-129 mg/dL (1.02-1.46 mmol/L)
• High: Greater than 130 mg/dL (1.47 mmol/L)

For young adults older than 19

• Acceptable: Less than 115 mg/dL (1.30 mmol/L)
• Borderline high: 115-149 mg/dL (1.30-1.68 mmol/L)
• High: Greater than 150 mg/dL (1.7 mmol/L)

Note: These values are based on fasting triglyceride levels.

When triglycerides are very high (greater than 1000 mg/dL (11.30 mmol/L)), there is a risk of developing pancreatitis in children and adults. Treatment to lower triglycerides should be started as soon as possible.

If you are diabetic and your blood sugar (glucose) is out of control, triglycerides may be very high.

Triglycerides change dramatically in response to meals, increasing as much as 5 to 10 times higher than fasting levels just a few hours after eating. Even fasting levels vary considerably day to day. Therefore, modest changes in fasting triglycerides measured on different days are not considered to be abnormal.

Certain drugs such as corticosteroids, protease inhibitors for HIV, beta blockers, and estrogens can increase blood triglyceride levels.

There is increasing interest in measuring triglycerides in people who have not fasted. The reason is that a non-fasting sample may be more representative of the “usual” circulating level of triglyceride since most of the day blood lipid levels reflect post-meal (post-prandial) levels rather than fasting levels. However, it is not yet certain how to interpret non-fasting levels for evaluating risk so, at present, there is no change in the current recommendations for fasting prior to tests for lipid levels.

For many people, high triglycerides are caused by another disorder, such as diabetes, obesity, renal failure, or alcoholism. With these conditions, the strategy is to treat the primary cause. When high triglycerides are not caused by another disorder, they are often seen together with high cholesterol and treatment is directed toward lowering both cholesterol and triglycerides. Lifestyle changes, such as a healthy diet and increased exercise, are usually the primary strategy for lowering levels. If these fail, lipid-lowering medications such as statins are generally recommended. For more on this, visit the American Heart Association’s webpage on Healthy Living.

A few products are available to test lipid levels, including triglycerides, at home. There are two types of home testing: those where you collect the sample at home and then mail it away to a laboratory for testing and those where you conduct the test yourself at home (self-monitoring). The American Heart Association hasn’t taken a position on the use of home testing devices for measuring lipid levels. Before making the decision to use one of these products, you may want to review the article about home testing on this site: With Home Testing, Consumers Take Charge of Their Health.

Very low-density lipoprotein (VLDL) is one of the major lipoprotein particles. Others include high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Each one of these particles contains a mixture of cholesterol, protein, and triglyceride but in varying amounts unique to each type of particle. LDL contains the highest amount of cholesterol. HDL contains the highest amount of protein. VLDL contains the highest amount of triglyceride. Since VLDL contains most of the circulating triglyceride and since the compositions of the different particles are relatively constant, it is possible to estimate the amount of VLDL-cholesterol by dividing the triglyceride value (in mg/dL) by 5. At present, there is no simple, direct way of measuring VLDL-cholesterol, so the estimate calculated from triglyceride is used in most settings. This calculation is not valid when the triglyceride is greater than 400 mg/dL. Increased levels of VLDL-cholesterol have been found to be associated with increased risk of heart disease and stroke.

Usually, most people with high triglyceride levels have no symptoms and the only means of discovering a high level is with blood tests. However, in rare cases, a person may have an extremely high level of triglycerides (well above 1000 mg/dL) sustained over time and the individual may experience repeated bouts of acute pancreatitis. Some of the signs and symptoms include pain in the upper half of the stomach area that develops suddenly and then gradually gets worse, fever, nausea, vomiting, and sometimes jaundice. A person with severely high levels may also develop lesions on the skin called xanthomas. These typically appear as several small, round, solid, yellow bumps mostly on the back, chest, buttocks, shoulders and thighs.