Triglycerides: What is it, Low, High and Treatment

Triglycerides are a type of lipid found in the blood and serve as a primary energy source. Elevated levels increase cardiovascular risk, while low levels may indicate metabolic disorders. Proper evaluation is essential for prevention and treatment strategies.

Causes of high triglycerides include obesity, diabetes, excessive alcohol intake, and genetic predisposition. Identifying underlying factors is crucial, as prolonged elevation may lead to atherosclerosis, pancreatitis, or coronary artery disease.

Low triglyceride levels may result from malnutrition, thyroid disorders, or chronic illness. Clinicians must assess possible systemic causes, as extremely low values can also impair energy metabolism and cellular functions.

Treatment of triglyceride abnormalities involves dietary adjustments, physical activity, and medical therapy. Omega-3 supplements, fibrates, and statins are commonly prescribed depending on the severity of dyslipidemia and associated comorbidities.

Medical Term	Triglyceride
Normal Value Range	< 150 mg/dL
High at the Border	150-199 mg/dL
High	200-499 mg/dL
Very High	≥ 500 mg/dL
Causes of Height	Excessive calorie intake (especially sugar and alcohol), obesity, diabetes, hypothyroidism, genetic factors
Causes of miscarriage	Malnutrition, hyperthyroidism, some genetic lipid disorders
Symptoms	Usually asymptomatic; at very high levels there may be a risk of pancreatitis
Related Risks	Coronary artery disease, stroke, pancreatitis
Diagnostic Methods	Fasting lipid profile (blood test)
Treatment Methods	Dietary changes, increased physical activity, lipid-lowering drugs (statins, fibrates, omega-3 fatty acids)

What is Triglyceride and What is its Main Function in the Body?

You can think of triglycerides as your body’s energy pantry. When you eat, the body immediately uses the calories it needs for its current activities. But excess calories, especially from sources such as sugar and carbohydrates, are not wasted. Our liver cleverly converts these excess calories into triglyceride packets.

These energy packets are then sent to fat cells where they are stored. Between meals, during exercise or any time the body needs extra strength, hormones open the door to this pantry and release the stored triglycerides to be used as energy. This system is vital for our survival. The problem starts not with the system itself, but with the fact that we constantly fill this energy pantry beyond its capacity. A certain amount of triglycerides is absolutely essential for a healthy body, but when its level in the blood increases uncontrollably, serious health risks begin to appear.

What is the Difference Between Triglycerides and Cholesterol?

Although triglycerides and cholesterol are often confused, they are two different types of lipids (fats) with completely different roles in the body. We can understand the difference with a simple construction analogy. If we think of cholesterol as the “bricks and mortar” that build cell walls, hormones and other structures, triglycerides are like the “fuel barrels” that run this construction machine.

One is a building material, the other a source of energy. Cholesterol is produced by the body in the liver and is the building block of cells. Triglyceride is basically the storage of unused calories and its level is directly influenced by the food we eat, especially sugar and carbohydrates. Neither can circulate in the blood on their own; they are packaged and transported by carrier proteins called lipoproteins. These transporters have names like LDL (bad cholesterol), HDL (good cholesterol) and VLDL, which we see in blood tests.

How Does the Body Produce and Store Triglycerides?

There are two main ways our body obtains triglycerides. The first comes directly from the food we eat. When you eat a meal that contains fat, the intestines absorb this fat and send it into the bloodstream. This is the body’s immediate response to external fat.

The second and usually more effective way is through production in the liver. Especially when we consume too much refined carbohydrates such as sugar, white bread, pasta or alcohol, the body cannot use this excess energy immediately. This is where the liver comes in and converts this excess sugar into triglycerides and releases them into the bloodstream. These triglycerides are transported in packages called VLDL and stored in fat cells. So even if you don’t eat a fatty meal, excess sugary and floury foods can turn into fat (triglycerides) in your body.

How are Triglyceride Levels Measured?

Finding out your triglyceride level is quite simple. This measurement is part of a comprehensive blood test known as a “lipid panel” or “lipid profile”. This test is one of the most basic tools for understanding your risk of cardiovascular disease. It is done with a small sample of blood taken from a vein in your arm. A standard lipid panel includes the following values:

• Total Cholesterol
• LDL Cholesterol (“bad” cholesterol)
• HDL Cholesterol (“good” cholesterol)
• Triglycerides

Why Fasting Before Triglyceride Testing is Important

There is a very important reason why your doctor asks you to fast for 8-12 hours before the test. We can liken this to measuring the fuel efficiency of your car. If you take the measurement immediately after refilling the tank, while driving at full throttle uphill, the result will not reflect the car’s performance at true “rest”.

After eating, especially after a fatty or sugary meal, the levels of triglycerides in your blood temporarily skyrocket. This is a normal part of the digestive process. Fasting counteracts this temporary spike and allows us to get a snapshot of your body’s fat metabolism in its baseline, or “resting” state. A high triglyceride level measured while fasting is not just an effect of your last meal, but a sign of a more persistent problem in the body’s fat processing and clearance system. Therefore, fasting is critical for the most accurate and reliable results.

What are Normal Triglyceride Levels?

So what should triglycerides be in a healthy individual? According to medical guidelines, the ideal fasting triglyceride level for adults is below 150 mg/dL. However, these numbers are not just a label; they are also a risk indicator. The higher the levels, the higher the risk. The table below shows the generally accepted triglyceride reference range.

Classification	Adults	Children and Youth (10-19 years)	Children (<10 years)
Normal (Healthy)	< 150	< 90	< 75
High at the Border	150 – 199	90 – 129	75 – 99
High	200 – 499	≥ 130	≥ 100
Very High	≥ 500	–	–

Some experts argue that the target should be below 100 mg/dL to maximize heart health. even the “borderline high” category is a warning sign to be heeded, especially if other risk factors (such as high blood pressure, diabetes) are present.

What is High Triglycerides (Hypertriglyceridemia)?

What is high triglycerides? This is the medical name for a higher than normal level of triglycerides in the blood. Unlike high cholesterol, high triglycerides usually cause no symptoms. This is why it is called a “silent danger”. You can only find out if it is present with a blood test.

Hypertriglyceridemia is often part of a larger picture. It is often associated with a condition called “metabolic syndrome”. Metabolic syndrome is a cluster of risk factors that seriously increases the risk of heart disease, stroke and diabetes. This cluster includes the following:

• Fat in the abdominal area
• High blood pressure (blood pressure)
• High blood sugar
• Low HDL (“good”) cholesterol
• High triglycerides

What is Low Triglycerides (Hypotriglyceridemia)?

What is low triglycerides? This is when blood triglyceride levels are abnormally low. Although not as often talked about as high levels, very low triglyceride levels can also be an important clue for a doctor. This is usually a sign of another underlying problem rather than a direct disease. Some conditions stand out among the causes of low triglycerides:

• Inadequate and unbalanced nutrition
• Food absorption disorders such as celiac disease
• Overactive thyroid gland (hyperthyroidism)

Low-normal levels in an athlete are usually a sign of good health, while the same value in a weak and sluggish person may be an indication of nutritional deficiencies.

What Are Lifestyle Causes of High Triglyceride Levels?

What causes high triglycerides? Often the answer lies in our lifestyle habits. While genetic predisposition is a factor, the following habits directly affect triglyceride levels:

• Taking in more calories than you expend
• Sugary drinks and sweets
• Products made with white flour (bread, pasta, pastries)
• Excessive alcohol consumption
• Living a sedentary life
• Smoking

Which Medical Conditions Lead to High Triglyceride Levels?

Sometimes high triglyceride levels can be a result or symptom of medical conditions beyond our control. The most common situations are the following:

• Insulin resistance and poorly controlled Type 2 diabetes
• Obesity, especially abdominal fat
• Slow thyroid gland (hypothyroidism)
• Chronic kidney diseases
• Non-alcoholic fatty liver disease
• Treatments such as certain blood pressure medications, cortisone and hormone medications
• Late pregnancy

How Genetic Factors Affect Triglyceride Levels

Some people may be genetically predisposed to high triglyceride levels despite living healthy lives. This condition is known as “familial hypertriglyceridemia” and can be passed down through generations in a family. If you have a family history of heart disease or high triglycerides at a young age, you are at increased risk. This genetic predisposition, combined with poor lifestyle habits, can cause triglyceride levels to reach much more dangerous levels.

How High Triglyceride Levels Increase the Risk of Heart Attack and Stroke

What happens if triglycerides are high? High triglyceride levels are considered an independent risk factor for heart attack and stroke. So even if your cholesterol is normal, just having high triglycerides increases your risk of cardiovascular disease. The higher the level, the higher the risk. High triglycerides accelerate the process of atherosclerosis, also known as arteriosclerosis, which is characterized by plaque build-up on the inner wall of the arteries. Over time, these plaques narrow blood vessels, obstruct blood flow and set the stage for clot formation, which can lead to a heart attack or stroke.

How High Triglyceride Levels Contribute to the Development of Arteriosclerosis

Triglycerides themselves do not directly adhere to the vessel wall and form plaque. But they mediate the formation of more dangerous particles that do. Think of it this way: Triglyceride molecules are like cargo ships that are too big to penetrate the vessel wall. But as these ships travel through the blood, they break up and leave behind smaller, denser, cholesterol-rich “remnant” particles. These small and insidious debris can easily infiltrate the vessel wall and accumulate there, triggering an inflammatory reaction. This reaction leads to the formation of fatty streaks, which are the first step towards atherosclerosis and, over time, develop into dangerous plaques. A high triglyceride environment also predisposes to easier blood clotting and increased inflammation in the blood vessels.

What Is the Association of Very High Triglyceride Levels with Pancreatitis?

When triglyceride levels exceed 500 mg/dL, and especially 1000 mg/dL, there is a completely different and more immediate danger besides the risk of heart disease: Acute pancreatitis. This is a sudden and severe inflammation of the pancreatic gland and can be life-threatening.

The body’s fat-clearing system has a certain capacity. When levels become too high, this system virtually fails. Excessive amounts of fat particles in the blood (chylomicrons) accumulate in the delicate and thin blood vessels of the pancreas, causing blockage. This blockage causes the pancreatic tissue to become anemic and damaged. The damaged pancreas releases powerful enzymes that begin to self-digest, leading to a dangerous condition characterized by severe abdominal pain, nausea, vomiting and requiring emergency hospitalization.

What Are Potential Causes of Low Triglyceride Levels?

Low triglyceride levels are usually caused by the following conditions:

• Restrictive diets with very low fat content
• Malnutrition (malnutrition)
• Diseases that impair the absorption of nutrients from the intestine (e.g. celiac disease)
• Overactive thyroid gland (hyperthyroidism)
• Use of certain cholesterol and triglyceride-lowering drugs

Do Low Triglyceride Levels Signal a Health Problem?

So is low triglycerides harmful? The answer to this question depends on the cause of the low levels. If this occurs in a person who eats a healthy diet and exercises regularly, it is usually not a cause for concern and may be a sign of a good metabolism.

But for a doctor, especially a cardiovascular surgeon preparing a patient for surgery, an unexpectedly low triglyceride level can be a warning sign. What looks “good” on paper may actually be an indication that the patient’s nutritional status is poor and that his or her body may not have sufficient energy reserves to handle the stress and recovery of major surgery. A low number is therefore not always good news and the underlying cause needs to be investigated.

What Lifestyle Changes Are Recommended to Lower High Triglyceride Levels?

The basis and most effective weapon in the treatment of high triglycerides is lifestyle modification. Although medications can be very helpful, it is difficult to achieve lasting success without correcting the underlying cause. Here are the first steps:

• Even losing 5-10% of your body weight can significantly reduce levels.
• Brisk walking, swimming or cycling for at least 30 minutes most days of the week.
• Alcohol is one of the biggest triglyceride raisers. It may be necessary to cut down or even cut it out completely.
• Quitting smoking is one of the most important steps you can take not only for your lungs but also for your entire vascular health.

What kind of nutrition plan should be followed to lower triglyceride levels?

A diet to control triglycerides is not a “starvation diet” but a diet of making wise choices. The basic principle is to reduce simple sugars and refined flours and replace them with fibrous and natural foods.

These are the main foods you should keep off your table:

• Sugary carbonated and fruit drinks
• Ready-made cakes, biscuits, sweets
• White bread
• White rice and pasta
• Processed meat products (salami, sausages)
• Foods containing trans fats, such as French fries

Here are the things you should include more in your table:

• Whole grains such as oats, whole wheat bread, bulgur
• Legumes such as chickpeas, lentils and beans
• A wide variety of colorful vegetables
• Fruits (with portion control)
• Oily fish such as salmon, mackerel, sardines (source of Omega-3)
• Raw nuts such as walnuts, almonds, hazelnuts
• Olive Oil
• Avocado

Which medicines are used to treat high triglycerides?

When lifestyle changes are not enough or the risk is too high, medication comes into play. The goal of treatment determines the choice of medication. If the aim is to reduce the risk of heart attack, different medicines are used; if the aim is to prevent pancreatitis, different medicines are used.

The most commonly used groups of drugs are statins, fibrates and prescription omega-3 fatty acids. Statins are the main drugs proven to reduce the risk of heart attack and stroke, especially by also lowering cholesterol. Fibrates lower triglyceride levels very strongly and are preferred to reduce the risk of pancreatitis, especially when levels are above 500 mg/dL. Prescription medications containing high doses of purified omega-3 (fish oil) are also very effective in lowering triglycerides, both alone and in combination with other medications. Your doctor will decide which medicine or combination of medicines is right for you based on your risk profile and blood values.

What Do the American Heart Association (AHA) and the American College of Cardiology (ACC) Recommend for Triglyceride Management?

These two world-leading health organizations provide a clear roadmap for triglyceride management. The key message of these guidelines is this: The first and most important step in treatment is always lifestyle modification. In addition, in patients at high risk of cardiovascular disease, statin therapy is highly recommended to control triglyceride levels and prevent future events. If triglyceride levels are high enough to pose a risk of pancreatitis (usually >500 mg/dL), fibrates or prescription omega-3 drugs are indicated to urgently reduce this risk.

Why is a Patient’s Triglyceride Level Important for a Cardiovascular Surgeon?

As a cardiovascular surgeon, when I look at a patient’s blood test results, I don’t just see numbers. Those numbers take me on a journey inside the patient’s vessels and tell the story of the vascular disease. A high triglyceride level is a strong signal that the underlying disease that brought the patient to the operating table is still active and aggressive. Triglyceride management is therefore not just a precaution but an integral and indispensable part of surgical treatment.

How High Triglycerides Affect the Outcomes of Surgical Procedures Such as Coronary Artery Bypass (CABG)

A bypass surgery is like building a new, clean highway around a blocked road. In surgery, we meticulously build this new road. But if you don’t remove the factors that keep causing accidents on the highway (i.e. high triglycerides), this new, clean road will deteriorate over time and become blocked again. Uncontrolled high triglycerides will cause both the bypass vessels we make and the patient’s own natural vessels to re-narrow at a faster rate. This jeopardizes the long-term success of the surgery and may lead to the patient needing another intervention or surgery. The success of the surgery is directly related to your compliance with postoperative triglyceride management.

How to Manage Triglycerides Before and After Surgery in Cardiovascular Surgery Patients?

Triglyceride management is a lifelong partnership that starts before surgery. Before surgery, your blood values give us important information about your metabolic risk. Postoperatively, we implement an aggressive management plan to ensure lasting surgical success. The cornerstones of this plan are:

• Starting or continuing high-intensity statin therapy
• Personalized, practical diet and nutrition counseling
• Create a workable exercise plan
• Adding additional triglyceride-lowering drugs to the treatment if necessary
• Optimizing treatment by monitoring blood values at certain intervals

How Your Cardiovascular Surgeon Can Guide You on Triglyceride Management to Reduce Your Risk of Vascular Disease

My role does not end when the surgery is over. Rather, it continues as a long-term partner in your journey to maintain your vascular health. You can look at triglyceride management as “insurance” for the bypass surgery we perform. We work together to make this insurance policy valid. I guide you through practical and effective dietary changes that you can easily implement into your life, rather than complicated diet lists. I’ll be in constant communication with your cardiologist and family doctor to optimize your medication and make sure we’re on target. Remember, our common goal is to ensure that the new pathways we build remain open for years to come, and the most important factor in achieving this goal is your belief in and compliance with the treatment.

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