▎WuXi AppTec Content Team Editor
Elevated levels of low-density lipoprotein cholesterol (LDL-C) are recognized as an independent risk factor for cardiovascular events, and lipid-lowering drugs represented by statins can effectively reduce LDL- C and reduce the incidence of cardiovascular events, has become the cornerstone of the prevention and treatment of ASCVD. At the same time, however, there is no clear conclusion on the optimal treatment for other types of dyslipidemia, such as abnormal triglyceride levels (eg, mildly or significantly elevated).
Recently, the journal Circulation published a major opinion paper on the potential causes of elevated triglyceride levels, the association between triglyceride levels and ectopic fat, and lower triglyceride levels. Effective means of esters are elaborated.
The paper emphasizes that for people with elevated triglyceride levels, it is necessary to detect liver fat intermediates (such as ALT±GGT, HbA1c) or imaging methods (such as liver ultrasound or magnetic resonance imaging) Resonance imaging) first to determine whether this abnormality is related to ectopic fat. Lifestyle modification is an effective intervention recommended for individuals with elevated triglycerides with ectopic fat.
Screenshot source: Circulation
What’s up with high triglycerides?
The results of previous studies suggest that LDL-C and triglyceride levels are largely regulated independently. That is, triglycerides can be elevated when LDL-C levels are normal, and vice versa.
In addition, there is growing evidence thatelevated triglyceride levels are causally related to the risk of developing ASCVD, independent of LDL-C. outside. Some scientists then hypothesized that larger triglyceride-rich very low-density lipoprotein particles also carry apoB (lipoprotein B), which also increases the risk of ASCVD.
In general,elevated triglyceride levels can be secondary to several types of specific diseases, including: nephrotic syndrome, liver disease, alcoholism, high carbohydrate/high Calorie diet, obesity and hypothyroidism, etc. In addition, poor glycemic control in diabetic patients (especially those with severe insulin resistance) can lead to elevated triglyceride levels in the body, and as glycemic control increases, Improvement, triglyceride levels will also return to normal.
The paper emphasizes that, with the exception of the less common hereditary dyslipidemia (caused by single-gene or polygenic genetic variation), if clinical treatment only focuses on elevated triglyceride levels itself , rather than its underlying cause, it is likely to miss the opportunity for effective intervention for the real cause.
Triglyceride levels are strongly associated with ectopic fat
The paper states that mildly or significantly elevated blood triglyceride levels are associated with ectopic fat (ectopic deposition of lipids in liver, muscle, etc.) in obese individuals form closely related. In this context, visceral and hepatic fat levels were elevated, and the liver was more likely to produce very low-density lipoprotein particles.
Specifically, higher triglyceride levels in most people are associated with persistent excess caloric intake that exceeds the fat storage capacity of subcutaneous fat depots, so excess calories are converted to fat Deposition in visceral and ectopic tissues, such as skeletal muscle, liver, pancreas and heart, or free in the blood circulation in the form of triglycerides.
Using blood chemistry, patient history, and physical exam results, we can more accurately determine when high triglyceride levels begin to cause ectopic fat formation and growth. In overweight/obese individuals, elevated triglyceride levels often coexist with hepatic steatosis, either directly (eg, by ultrasound or magnetic resonance imaging) or indirectly (ALT or MRI) γ-GGT level determination) detection method to verify.
▲Methods to determine whether elevated triglyceride levels are associated with ectopic fat (Image source: References[ 1])
Including triglyceridesfactors such as ALT or gamma-GGTrelevant to liver fat are also It is also strongly associated with the risk of developing diabetes (even more so than ASCVD). Typically, elevated fat-related triglyceride levels often coincide with mild or significant increases in blood sugar.
The paper emphasizes that, under relevant circumstances, the increase in ALT levels may be relative, that is, may not exceed the upper limit of the normal range (0~40 U/L). However, even ALT levels30-35 U/L were independently associated with a higher risk of developing diabetes (compared to Furthermore, many individuals with normal ALT levels Individuals may also have excess liver fat.
Overall, clinically higher triglyceride levels in patients may be a manifestation of ectopic fat. Combining the blood test indicators of triglyceride, ALT, GGT, glycosylated hemoglobin (HbA1c) and/or fasting blood glucose, we can judge the presence of ectopic fat in the liver or other parts of an individual. Since the vast majority of patients with type 2 diabetes have excess ectopic fat, we will be able to more accurately determine the presence of ectopic fat by combining the patient’s weight, diabetes history, and biochemical test results.
How can I lower my triglyceride levels?
Previous clinical studies have confirmed that pharmaceutical interventions, such as fibrates and niacin, are generally not effective in reducing triglyceride levels, nor can The prognosis of ASCVD has a significant impact.
Although some argue, more research is needed to further clarify the underlying causes of elevated triglyceride levels and ectopic fat formation. However, so far, there is good research evidence that lifestyle adjustments, including optimizing diet to reduce body weight and increasing exercise levels, can reduce ectopic fat and improve triglyceride, ALT, GGT, and HbA1c levels at the same time.
The paper emphasizes that weight loss and lower triglyceride levels through lifestyle changes also reduce the risk of ASCVD, and that, unlike medications, lifestyle changes can also improve an individual’s life. quality and therefore have important intervention implications.