Nov 28, 2009
8/6/09 (on tube feeds, non-fasting study) HDL=26; LDL=120; VLDL=31.4; Chol=177 10/7/09 (on tube feeds, some food po, fasting study) HDL=27; LDL=84; TG=317; Chol=174 11/4/09 (all food po, non-fasting study) HDL=20; LDL couldn't be calculated; TG=510; Chol=179
Walk 30 min/d 4x/wk; not obese; don't smoke
Thoughts on ways to improve numbers? Which niacin med do you prefer? Omega-3 fatty acids?
Response from Dr. Young
Hello and thanks for your post on the topic of lipids. A timely one, given our recent Thanksgiving feasting holiday.
Lipid levels are of concern since they are related to risk of cardiovascular disease. This stated, it is important to be mindful of the fact that there are multiple risk factors (including genetics, gender, exercise, smoking, diabetes and hypertension) that ultimately determine one's relative risk of disease-- lipid are just one of these.
Only one of your lipid data can really be evaluated-- namely the fasting value from October. Non-fasting tests really shouldn't even be run; they are a waste of money and effort. How one interprets these tests is in the context of those other cardiovascular disease risk factors. Typically we'll use the Framingham equation risk calculator . In this regard, I'm heartened (pun intended) to learn of your exercise and smoking habits. I should point out that all of these habits generally tend to improve lipid values.
Assuming otherwise average risk, we could view those October results as follows: Your LDL cholesterol (the "bad" cholesterol) as acceptable; your HDL (the "good" cholesterol) level is modestly low. The more striking abnormality, as you point out from your question, is your triglyceride levels.
Trig levels are both a function of family history (or genetics),diet and medication effects. Higher fat diets have a large influence on trigs that cholesterol; it would be valuable to look at your diet to see if this can be improved. HIV medications (particularly ritonavir) are also associated with increased triglycerides- in some cases, we'll entertain switch from ritonavir-boosted PIs to other medications for very elevated trigs.
As for medication treatments for hypertrigylceridemia, we'll consider using fibrates, nicacin or omega-3 fatty acids (fish oils). There's no one approach that works for all, but regarding your question, we typically will use an extended release niacin, since they tend to be better tolerated (less skin flushing); though some people tolerate the generic immediate release just fine. Omega 3's come as over-the-counter fish oil or in a prescription (purified) medication. Both are effective in lowering trigs, though it's easier to get sufficient quantities of O3's with the prescription version (and less fish smell too).
I hope this is a helpful start; I'd discuss your particular situation and optimal management strategy with your healthcare provider.
Be well, BY
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