Bad News: High Triglycerides Are Linked to Stroke Risk. Good News: You Can Do Something About It!

Harvard Heart Letter February 2008

This week's November 12, 2008 issue of JAMA (Journal of the American Medical Association) brought good news to me.  High levels of blood fats, known as triglycerides, are linked to an increased risk of stroke.  And the good news is that triglycerides are closely associated with what you put into your mouth.  Which means you CAN control your triglyceride levels with diet.  Since both my parents & grandparents suffered disabling strokes--a risk factor that I can control is excellent news!  Believe me, I would take a non-fatal heart attack over a stroke any day.

What exactly are triglycerides?

Triglycerides are fats carried in the blood from the food we eat. Most of the fats we eat, including butter, margarines and oils, are in triglyceride form. Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body. For more info click here.

Eat a cheeseburger and your digestive system will rip apart the triglycerides in the meat & cheese and release them into your blood stream, where they eventually turn into dense LDL cholesterol that burrows right into your artery walls.  And to make matters worse, the higher your triglycerides, the lower your good HDLs will be.  Bad news because that's the cholesterol that removes the LDL from your blood and artery walls. The goal is: Low triglycerides + High HDL = Lower risk of stroke

Large Danish Study Clearly Shows High Triglycerides Are Linked to a Higher Stroke Risk

• 14,000 Danish men & women participated in this 31-year study.  Lots of people--many years-- good data.
  
• Ischemic stroke is associated with high triglyceride levels--it's the most common type--and it occurs when a clot blocks a blood vessel in the brain.
• The highest levels of triglycerides--above 443 mg/dL had a 3 to 4 fold higher risk than levels less than 89 mg/dL.
• The triglyceride/stroke association is higher than that of the cholesterol/stroke association!
• This is one of only a few studies that has looked specifically at a link between high triglycerides and stroke. Several have linked triglycerides with cardiac events.
  

This Study Used Non-Fasting Triglyceride Measurement--Unlike the U.S. Practice

• The Danes didn't measure triglyceride levels the usual way--after a 12 hour fast. 
  
• They took blood readings at any time, in spite of when a meal was eaten.
• This method is definitely easier for the patients.
• It may be a more accurate method because triglycerides rise & fall throughout the day based on what you've eaten.  A high fat meal takes longer to clear.
• Non-fasting measurements may be more accurate.  Slower clearance of triglycerides after eating may indicate insulin resistance &/or greater exposure to the triglyceride's dense atherosclerosis byproducts than people who get rid of them quickly experience.
• All Copenhagen hospitals now use the non-fasting method to measure triglyceride levels.
• 2 large studies reported on last year used the non-fasting method and concluded this was a better more accurate practice.

What Can You Do to Lower Your Triglyceride Levels?

• Eliminate bad fats.  Cut out saturated fat--red meat--full-fat dairy foods.  Eliminate trans fat--fried foods--commercially prepared baked goods.
• Eat only whole grains.  Eliminate white flour, white rice, sugared soda.
• Cut back on sugar. Even too many fruits can raise triglycerides in some people. If your triglycerides are high--eat whole fruit (not juice) & limit quantities to 2/day. Increase your vegetable intake.
  
• Watch your alcohol consumption. In some people alcohol dramatically raises triglycerides.  You'll only know if you respond to alcohol this way by eliminating it, & then measuring your triglycerides.
• Increase you omega-3 consumption.  Eat salmon or other high omega-3 fish twice a week. Add ground flax seed and a small amount of walnuts.  Supplementing with highly refined pharmaceutical grade fish oil capsules will lower triglycerides.  Check with www.consumerlab.com for the best brands. OmegaBrite & Minami brands were given the "very highest" ratings by Consumer Labs.
  
• Exercise lowers triglycerides and increases HDLs
• If you're overweight, losing just 5% - 10% of your weight will lower your triglycerides.  When you lose weight, belly fat is the first to go & that's associated with higher triglycerides. For more incentive to ditch the belly fat, click here.
  

Women Watch Out!--High Triglycerides Are Better Indicators of Cardiac Risk Than Cholesterol Levels

• A large 25 year Danish study reported in JAMA  July 2007 showed women with the highest non-fasting triglycerides were five times more likely to die of a cardiac event than women with the lowest levels.  Men with high triglycerides had only twice the risk of men with the lowest levels.
• A large 10 year Harvard study following 26,000 women, also reported in JAMA July 2007, found that the 2-4 hour post-eating triglyceride levels were better indicators of future cardiovascular risk than were cholesterol levels or insulin resistance.  Measurements taken longer than 4 hours after a meal were less accurate. Fasting measurements of triglycerides (the usual method) were not accurate indicators of risk!

Bottom Line: Consider asking for a 2-4 hour post meal measurement of your triglycerides to accurately assess your risks.  Cut out saturated fat, sugar, refined carbs.  Exercise & eat your omega-3's.

My Triglyceride level: I usually clock in at 44-80 mg/dL with the fasting triglyceride test. It would be interesting to see if the numbers stayed the same if taken 2-4 hours after a meal.  I'm not on statins, and because of my family history of strokes and heart disease I dose up on whole grains--omega 3's (flax, fish, walnuts, fish oil)--eat lots of veggies (less fruit)--limit saturated fats and animal products.  I guess it works!

If You Need Prescription Drugs to Lower Your Triglycerides--Here Are Your Choices.

Harvard Heart Letter February 2008

Notice that fish oil has a similar lowering effect to prescription statins.  My husband experienced intolerable flushing and itching at therapeutic levels of Niacin & Niaspan, but that's just his experience.  Tricor should be used with caution in combination with statins.

Comments

[Healthy Oil Guy]

Excellent research references for this article. I like to mix a tablespoon of ground flaxseeds with my morning cup of orange juice. I get the benefits of omega 3 fatty acids, fiber and lignans, along with a dose of tasty vitamin C!

[Kairol Rosenthal]

Hi,

I found your blog via Tara Parker-Pope's and love it. Perhaps you are my alter ego. I have always dreamed of becoming a medical librarian, but instead fill the yearning by spending hordes of time in consumer health libraries, geeking out online, and researching and writing about the young adult cancer community for my Everything Changes blog and book. I'm excited to share your blog with my readers.

Best,
Kairol
http://everythingchangesbook.blogspot.com/

[Mary Finke]

I have heard that flax seed was tested on rats and proved to be advantageous. However, human's can't digest it the same way and therefore it's value is minimal. Have you heard about his theory and what do you think?

[The Healthy Librarian]

Hey Mary,

You just grind the flax seed--otherwise it passes right through you. Or buy it already ground as flax meal (Bob's Red Mill). But be sure to keep the flax seed or meal in the fridge so it doesn't turn rancid.

Lots of new literature (large studies) out recently saying it lowers cholesterol--& so many wonderful omega-3 properties--I try to eat a couple tablespoons daily. Try it--you'll like it! Or use high quality fish oil. When I have a chance, I'll summarize some of the new favorable literature recently out on flax seed.