Lifestyle Approaches to Lowering Triglycerides

Epidemiological studies have identified elevation in blood triglyceride levels as being associated with an increased risk of cardiovascular disease (CVD). Compared to optimal fasting triglyceride levels (i.e., less than 100 mg/dL), levels greater than 150 mg/dL are more likely to be uncovered in patients who are overweight, physically inactive and have other metabolic abnormalities, including insulin resistance, Type 2 diabetes mellitus, and hypothyroidism. Recent Mendelian randomization studies support a causal relationship between hypertriglyceridemia and CVD and genetic mutations in candidate genes have been shown to directly or inversely correlate with CVD risk. Lifestyle therapy should be initiated in patients with elevated triglyceride levels, especially those who are overweight or obese because a 5–10% reduction in body weight may reduce triglyceride levels by 20–30%. Dietary strategies to reduce TG levels include overall fat reduction, elimination of trans fatty acids, increased consumption of omega-3 polyunsaturated fatty acids (PUFAs), substitution of saturated fatty acids derived from animal and plant sources (e.g., tropical oils) with monounsaturated fatty acids and PUFAs, and replacement of refined starchy foods and simple sugars with fiber-rich foods like fruits, vegetables, and whole grains. Physical activity may also contribute an additional 20% reduction in triglyceride levels. Taken together, lifestyle approaches may lower triglyceride levels by approximately 50%, thereby improving overall cardiometabolic risk.