High cholesterol and triglycerides
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High Cholesterol and Triglycerides: Cardiovascular Risks and Management Strategies
Elevated Triglycerides and Cardiovascular Risk
Elevated triglycerides are a significant risk factor for cardiovascular disease (CVD). Studies have shown that high triglyceride levels are associated with an increased risk of major cardiovascular events, including nonfatal myocardial infarction, nonfatal stroke, and the need for coronary revascularization. This risk persists even when other lipid levels, such as high-density lipoprotein cholesterol (HDL-C), are well-managed. Elevated triglycerides are also linked to higher healthcare costs and increased hospital stays.
Triglyceride-Rich Lipoproteins and HDL-C
Triglyceride-rich lipoproteins (TRLs) and low HDL-C levels are both critical factors in cardiovascular risk. Evidence supports a causal relationship between elevated TRLs and cardiovascular events, with low HDL-C levels also contributing to increased risk. The management of these lipid abnormalities often involves lifestyle interventions and pharmacotherapy, including the use of niacin or fibrates, especially when lifestyle changes alone are insufficient.
Triglycerides and Non-HDL Cholesterol in Diabetes
In individuals with type 2 diabetes, high triglyceride levels combined with high non-HDL cholesterol significantly increase the risk of cardiovascular disease. This risk is particularly pronounced in those with abnormal glucose metabolism, where the combined presence of high triglycerides and non-HDL cholesterol doubles the risk of cardiovascular events.
Triglyceride/HDL-C Ratio as a Risk Marker
The triglyceride to HDL-C ratio (TG/HDL-C) is a useful marker for identifying individuals at high risk for cardiovascular disease. A higher TG/HDL-C ratio is associated with increased carotid artery intima-media thickness, insulin resistance, and nonalcoholic fatty liver disease (NAFLD) in children and adolescents. This ratio is also linked to microvascular complications in type 2 diabetes, such as retinopathy and chronic kidney disease.
Therapeutic Approaches
Managing elevated triglycerides involves both lifestyle changes and pharmacological treatments. Lifestyle interventions include dietary modifications, increased physical activity, and weight management . Pharmacological options include fibrates, omega-3 fatty acids, and emerging drugs like volanesorsen and pemafibrate, which target specific components of lipid metabolism. However, the effectiveness of these treatments in reducing mortality remains inconsistent.
Conclusion
High cholesterol and triglycerides are critical factors in cardiovascular risk, particularly in individuals with diabetes and other metabolic disorders. Effective management requires a combination of lifestyle interventions and targeted pharmacotherapy. Monitoring and addressing both triglyceride levels and HDL-C can significantly reduce the risk of cardiovascular events and improve overall health outcomes.
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