The Cholesterol Concentration, is that really the Culprit in CHD?
Thrombosis is the most common complication associated with acute coronary syndrome (ACS). Newer therapies to prevent the hemorrhagic complications are constantly arising on the horizon. However, a recent study published in the Journal of Cardiology (Feb.12, 2008) demonstrated that perhaps we need to holistically target the lowering of triglycerides and LDLs instead of just focusing on the overall cholesterol value in looking at cardiovascular risk and its complications.
In post-ACS patients, achieving low triglyceride levels along with a low LDL level should be considerations. In the past, triglycerides have been somewhat ignored, in part, the researcher stated “because clinicians didn’t know what to do about them”. Dietitians, however, have had access to low triglyceride diets for years. In fact, the National Cholesterol Education Program makes strict reference to controlling triglycerides and sets a limit of <150 mg/dl for them.
Dr. Michael Miller, one of the lead investigators for this study, stated that what the conclusions pointed to in his study were that triglycerides are important at every level of cholesterol control and that in post-ACS patients low triglycerides are associated with reduced risk of cardiovascular complications. He stated that their role in predicting future coronary events has been de-emphasized.
In previous studies, keeping triglyceride levels less than 150 mg/dl was associated with a 20% reduced risk of coronary heart disease compared with patients with levels greater than 150. For every 10 mg/dl decrease in triglyceride levels, the incidence of death, MI and recurrent ACS decreased approximately 1.5% even after adjustment for LDL, non-HDL and other co-variates.
Miller explained that triglycerides themselves are not atherogenic because they are broken down into free fatty acids and used as energy. However, they are metabolized into cholesterol rich remnant particles that are atherogenic – perhaps as atherogenic as LDL. With diet and exercise, triglycerides can be reduced by between 20-40%.
The diet for triglyceride reduction focuses on a healthy balanced diet high in water-soluble fibers, and low in sugar and alcohol. For further information, contact your local Registered Dietitian. Need help finding one? Go online to www.eatright.org and get help from the American Dietetic Association in locating one near you.
About the Author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
