FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

"HYPERTRIGLYCERIDEMIA"-- EASIER TO TREAT THAN PRONOUNCE

Question: I'm a 47 year-old woman. I am not overweight, and I watch the amount of fat in my diet because I have a family history of high triglycerides. My triglycerides are 1390 even after taking Tricor. What effect does this high triglyceride level have on my body, especially the pancreas?

Answer: Triglycerides are fatty molecules that are normally present in the blood in levels up to 150 mg/dL in adults. Levels from this normal level to 500 are Òinteresting,Ó while those over this deserve further evaluation. Obviously, your value of 1390 requires medical attention.

High triglycerides, what we doctors call "hypertriglyceridemia," is sometimes seen by itself, but more commonly, the person with this disorder also has elevated cholesterol and blood sugar levels. You didn't tell me if you have these other lab test abnormalities or not. Since you didn't mention them, I'll assume that you have the less common disorder of increased triglycerides alone. I'll also assume that you do not have the condition as a result of taking some medicine. Estrogen, in either birth control pills or as part of hormone replacement therapy, beta-blockers, diuretics, steroids, cortisone, isotretinoin and alcohol are the most commonly implicated ones.

About 2 percent or less of the population has hypertriglyceridemia without any other apparent problem. In these cases, it is an inherited disorder affecting the way the liver assembles or disassembles fatty molecules. It is inherited as a dominant gene and is not related to gender. This is probably what you have since you mentioned that you have a family history of the condition.

Triglyceride levels above 1000 can cause inflammation of the pancreas. This produces significant abdominal pain, and without treatment it can progress to become a life-threatening illness. Fortunately this doesn't happen that often. Triglycerides at your level also brings with it some increased risk of heart attack and stroke. The magnitude of the increased risk, however, is determined to a great degree by other risk factors such as family history, use of tobacco, exercise, etc.

Triglycerides over 1000 also have a risk of injury to the liver, spleen, lymph nodes, retina and skin. Fortunately, having a risk of these conditions doesn't mean that it will actually happen to you. Taking measures to reduce your triglycerides will greatly reduce the risk of all of these problems.

The Tricor you are taking is an excellent medicine for this disorder. In addition to the drug, it is important to keep your weight near the ideal level. You should also eat a diet that is low in fat, since your body doesn't metabolize it properly. You should select your food so that about 30 percent of your total daily calories come from fat, 50 to 55 percent from carbohydrates and the remainder from proteins. It is also important that the carbohydrates you consume are of the complex type -- what you get from vegetables, whole grains and fruits. In other words, no sugar, white bread, white rice, potatoes or pasta should be in your meal plan. Some day there may be a genetic cure for your condition. Today, however, the treatment of hypertriglyceridemia is a life-long process that can result in a long and healthy life.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.