June 20--Preventing heart disease may be about more than reducing low-density lipoprotein, or "bad" cholesterol, according to a pair of studies published Wednesday.
Those studies, appearing in the New England Journal of Medicine, show patients with mutations that break a gene the body uses to make triglycerides -- or fat particles in the blood -- have a 40 percent reduction in their risk of heart disease.
"Often, the medical community focused itself on lowering LDL cholesterol only," said Dr. Mahmoud Sharaf, medical director of St. Joseph's Hospital's cardiopulmonary rehabilitation program and a doctor with Eau Claire Heart Institute. "We were perhaps less aggressive in lowering triglycerides. Based on this, we might need to be more stringent."
Medical professionals have long noticed a connection between triglycerides, cholesterol and heart health. High-density lipoprotein, or "good" cholesterol, protects against heart disease while "bad" LDL cholesterol and triglycerides, when elevated, increase risk, Sharaf said.
"We feel LDL and triglycerides not only directly contribute to disease but are markers of inflammation and involve interaction with other very complex pathways," he said. "The truth is, scientists are only scratching the surface of how complex these interactions are."
Susan Pope, nurse practitioner in the cardiac center at Mayo Clinic Health System in Eau Claire, said a lipid profile has different parts and triglycerides are just one of the factors they look at.
"The triglyceride/HDL picture has not been as clear as the LDL picture, and this study is a potential step toward that," Pope said.
Susan Kasik-Miller, a dietitian with Sacred Heart Hospital in Eau Claire, said it's interesting that researchers have discovered people who are efficient at metabolizing triglycerides, lowering their risk of heart disease.
"I think one of the things that has been on the forefront of everyone's mind is having some type of genotyping to determine people's risk for various diseases," she said. "We already do some of that. ... This is just another genetic basis for determining people's risk for heart disease."
Medical professionals recommend a triglyceride level of 150 mg/dl or less. Fats, sugar and alcohol can all affect those levels, Kasik-Miller said.
Sharaf said the studies might lead to using more combination therapy -- using classes of medications such as fibrates (acids used to treat metabolic disorders) along with conventional statins such as Lipitor -- to treat heart disease.
"Up till now, many patients are only on statins, addressing the LDL aspect of the equation, but ignoring largely the triglyceride aspect," he said.
Simple changes such as improving diet, exercising more and losing weight all can help reduce triglyceride levels.
"Those kind of changes in lifestyle can help lower triglycerides tremendously," Mayo Clinic Health System's Pope said.
Miels can be reached at 715-833-9214, 800-236-7077 or firstname.lastname@example.org.
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