Diet, Exercise Sufficient to Reduce Triglycerides

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http://pubget.com/paper/21502576?title=Triglycerides+and+Cardiovascular+Disease%\

3A+A+Scientific+Statement+From+the+American+Heart+Association

Diet, Exercise Sufficient to Reduce Triglycerides

By Kaiser, Cardiology Editor, MedPage Today

Published: April 20, 2011

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

Harvard Medical School, Boston and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

While cholesterol control is often balanced between statins and lifestyle

changes, reducing triglycerides can usually be accomplished with diet and

lifestyle changes alone, according to a new scientific statement from the

American Heart Association.

" It is especially disconcerting that in the U.S., mean triglyceride levels have

risen since 1976, in concert with the growing epidemic of obesity, insulin

resistance, and type 2 diabetes mellitus. In contrast, mean low-density

lipoprotein cholesterol levels have receded, " according to the statement

published online April 18 in Circulation.

The researchers analyzed more than 500 international studies from the past 30

years in an effort to update clinicians on the role of triglycerides in the

evaluation and management of cardiovascular disease risk.

Action Points

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Explain that a new scientific statement from the American Heart Association

recommends diet and exercise changes to lower triglycerides.

Point out that this review of available studies reaffirms that triglycerides are

not directly atherogenic but are markers of cardiovascular risk.

Led by , MD, director of the Center for Preventive Cardiology at

the University of land School of Medicine in Baltimore, the researchers

reaffirmed that triglycerides are not directly atherogenic but represent an

important biomarker of cardiovascular disease risk.

They suggested that clinicians should better understand the " metabolic pathways

of triglyceride-rich particles and the consequences of hypertriglyceridemia, "

particularly in knowing the " characteristic lipid alterations in diabetes

mellitus, lipodystrophic disorders including those seen with HIV, and chronic

renal disease. "

For those outside the normal range of triglycerides, and colleagues

recommend limiting:

Added sugar to less than 5% to 10% of calories consumed -- about 100 calories

per day for women and 150 calories per day for men

Fructose from both processed foods and naturally occurring foods -- less than 50

to 100 grams per day

Saturated fat to less than 7 percent of total calories

Trans fat to less than 1 percent of total calories

Additionally, for persons with especially high triglyceride levels -- greater

than 500 mg/dL -- et al. recommend abstaining from alcohol to guard

against pancreatitis.

The recommendations encourage all patients with triglyceride levels in the

borderline to high range (150 to 199 mg/dL) or greater to incorporate physical

activities of at least moderate intensity (such as brisk walking) for a total of

at least 150 minutes per week, because these activities may contribute an

additional 20% to 30% triglyceride-lowering effect.

" Overall, the treatment of elevated triglyceride levels focuses on intensive

therapeutic lifestyle change, " they wrote.

" For example, a 5% to 10% reduction in body weight anticipates a

triglyceride-lowering response of 20%. Further offsets in carbohydrate calories

by reducing added sugars and fructose while increasing unsaturated fat intake

may contribute an additional 10% to 20% reduction in triglyceride levels. "

Further reduction or elimination of trans fats and increased consumption of

marine-based omega-3 products, along with aerobic exercise, will result in

optimal lowering of triglycerides.

" Taken together, reductions of 50% or more in triglyceride levels may be

attained through intensive therapeutic lifestyle change, " they concluded.

The statement also concludes that the use of medications to lower triglycerides

" is still lacking crucial clinical trial evidence. " Except to prevent

pancreatitis for those with triglyceride levels above 500 mg/dL, the

recommendations are to avoid triglyceride-lowering medications but to review

medication lists for drugs that might be raising triglycerides.

Triglyceride testing is traditionally taken after a 12-hour fast. The authors

suggest using non-fasting triglyceride testing as an initial screen. Although

the cutoff for elevated triglycerides remains at 150 mg/dL, a new optimal level

of 100 mg/dL has now been set to acknowledge the protective benefit of lifestyle

in metabolic health, the authors noted.

Theodore Mazzone disclosed relationships with Takeda, Merck, Abbott

Laboratories, and GlaxoKline.

Subramanian Pennathur disclosed a relationship with Merck/Schering-Plough.

Fazio disclosed relationships with Isis and Merck.

Ron Goldberg disclosed relationships with Abbott and GlaxoKline.

W.F. disclosed relationships with Liposcience and Merck.

Primary source: Circulation

Source reference:

M, et al " Triglycerides and cardiovascular disease: A scientific

statement from the American Heart Association " Circulation 2011; DOI:

10.1161/CIR.0b013e3182160726.