The ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio." (Circulation 1997;96:2520-2525).

However, the association between triglycerides and HDL cholesterol is the most difficult to sort out. It turns out that whenever triglycerides are increased, HDL cholesterol decreases. So is the increased risk seen with high triglycerides due to the triglycerides themselves, or to the associated reduction in HDL cholesterol (the "good" cholesterol) and increase in LDL cholesterol (the "bad" cholesterol). So far, nobody can say for sure.

The problem is, people with elevated triglyceride levels almost invariably have other major risk factors for heart disease (mainly obesity, diabetes, and/or high blood pressure), and, so far, it has not been possible to sort out whether the triglycerides themselves pose an independent risk.

However, they had a 300 percent greater risk for coronary artery disease when they had both high blood triglyceride levels combined with high levels of LDL cholesterol.

Add borderline high blood pressure (140/90 mmHg or higher), and those people suffered a 500 percent increase!

Presence of excess triglycerides in the blood causes the viscosity (thickening) of blood and reduces the ability of arteries to enlarge. Each time, after high fat meals, your systemic arterial compliance (SAC) becomes decreased, what reflects primarily the stiffness of the aorta - the stiffer the aorta, the worse (Journal of the American College of Cardiology, June 1, 2000).

Triglycerides in higher amounts are significantly interrelated to the metabolism of HDL-"good" and LDL-"bad" cholesterol. They make the blood

• more "sluggish" and
• less capable of transporting oxygen to the tissues, particularly through the smallest blood vessels.

The study provides a potential rationale for advocating much lower fasting triglyceride levels than those currently considered “desirable” (American Heart Association’s Scientific Sessions in Anaheim, California, November 13, 2001). Further, the study suggests less than 100 mg/dL is more appropriate, because once a meal is consumed, triglyceride levels rise.

Even when people have acceptable fasting triglyceride levels (the levels of triglyceride circulating in the blood after fasting overnight), after a high fat meal their triglyceride shoots up into levels that could put them at higher risk of heart disease. However it is entirely possible that if people can lower their baseline triglyceride levels with diet changes and exercise, their heart disease risk may drop throughout the day, even after eating high fat meals.

In addition, the study evaluated the implications of “desirable” fasting triglyceride in 50 healthy, non-obese men and women with normal cholesterol levels, whose average age was 35.

After their fasting triglyceride was measured, each volunteer was given a milkshake, standardized at 70 grams of fat per square meter of body surface. Their triglycerides after a milk shake were measured at intervals of two, four, six, eight and ten hours.

For volunteers with a fasting triglyceride between 101 and 149, the triglyceride level at the peak, four hours after consuming the shake, averaged 200 mg/dL, putting them at dangerously high levels, despite the acceptable fasting levels.

However, in volunteers with a fasting triglyceride of less than 100, the four-hour peak triglyceride after the milkshake was only 124 mg/dL on average.

People with triglyceride levels at or above 100 were 50 percent more likely than those with lower levels to suffer from future heart attacks, need bypass surgery or angioplasty, or die from heart disease.

The average triglyceride level in the United States is 134 mg/dL and is considerably higher than triglyceride levels below 100 mg/dL commonly observed in countries where heart disease rates are low.

Higher triglyceride levels are associated with not only increase in body weight but also a disturbing increase in diabetes. It is a two-sided problem, because people with high triglycerides often develop insulin resistance, a major factor in the most common type of diabetes. In some cases, high triglycerides are identified years before the onset of diabetes.

Triglyceride is a fat that always circulates in the blood, especially after a meal high in saturated fat. Enzymes normally break down these fat particles, but when the process is not working efficiently, triglycerides that are only partially broken down can cause fatty deposits in blood vessels, leading to atherosclerosis, also known as narrowing of the arteries.

In the December 11, 2001, edition of the medical journal Circulation, it was noted that ischemic strokes, or brain attacks, which occur when a clot or narrowed artery cuts off the brain’s blood supply, account for about 80 per cent of all strokes. The other 20 per cent are due to broken blood vessels in the brain.

Further, it was noted that people with more than 200 mg of triglycerides per dL of blood were nearly 30 per cent more likely to have an ischemic stroke, or TIA, than people with lower levels of the blood fats.

In pancreatitis (inflammation of pancreas), pancreatic enzymes begin to digest the pancreas itself. This condition may lead to

• kidney failure
• ARDS (acute respiratory distress syndrome)
• coma, or
• multisystem organ failure.

Furthermore, if you have elevated serum triglycerides it may indicate that

• you have some problem with insulin, either a pre-diabetic state, or frank diabetes; or
• you drink excessive amounts of alcohol and
• your liver isn't functioning properly.

If you have coronary heart disease, diabetes mellitus (type 2, or non-insulin-dependent diabetes), or multiple risk factors, your triglyceride goal should be less than 100 mg/dL (but not lower than 70 mg/dL).