Got High Triglycerides? Check out our New Decision Pathway from the American College of Cardiology

For decades, triglycerides (TGs) took the proverbial back seat in the lipid/lipoprotein hierarchy.  In recent years, however, TGs have gained increasing traction as a bonafide and independent biomarker of cardiovascular risk based on a series of well conducted epidemiologic and genetic (Mendelian randomization) studies.

Earlier this month, the American College of Cardiology released a new document that systematically outlines a series of decision trees that clinicians and health care professionals might consider when treating patients with elevated TG levels.  It was a great privilege to work with colleagues and “lipid luminaries” in an highly engaging effort spearheaded by Drs. Salim Virani and Pam Morris.

Listed below are some of the highlights of the document that can be accessed by clicking here.

1. Lifestyle interventions should be initiated in adults with fasting triglyceride levels of 150 mg/dL or non-fasting triglycerides of 175 mg/dL or higher.
2. Among lifestyle recommendations for treating high triglycerides, weight loss is among the most robust (10-20% reductions on average) with up to 70% reductions potentially achievable.
3. Dietary recommendations to lower elevated triglyceride levels include switching from a low-fat, high carbohydrate diet to a higher-fat (predominantly mono/polyunsaturated) and low-carb diet (30-40% of calories).
4. In men and women with the metabolic syndrome, a high protein/weight loss diet (greater than 25% of energy intake/500 calorie per day deficit) is associated with ~35% reduction in triglycerides.
5. Physical activity and exercise may contribute up to a 30% reduction in triglyceride with both resistance training and aerobic activity contributing to these effects.
6. Excess alcohol consumption, especially with pre-existing high triglyceride levels can precipitate pancreatitis.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland. 

Lift Weights to Lose Weight

 

A new study shows that lifting weights/resistance training 2 or more days a week for as little as 30 minutes per session is associated with or a 20-30% lower risk of developing obesity over a 6 year period. In addition to traditional weight machines and free weights, muscle strengthening/tone activities include full body squats, pushups, planks and other core exercises.

This study adds to the growing evidence that muscle toning exercises are cardioprotective.  Among the first studies to demonstrate heart protection was the “Harvard Health Professionals’ Follow-Up Study, which found that weight training for at least 30 minutes each week resulted in a 23% lower risk of a heart attack or death from heart disease”**

Shown below are several other reasons why weight/resistance training aimed at muscle toning should be part of your overall physical fitness prescription to improve cardiometabolic health by reducing the following:

1. Type 2 diabetes: A study of nearly 4700 adults found that moderate weight training that resulted in increases in muscle mass (assessed by bench and leg press) reduced the risk of developing Type 2 diabetes by 32% over an 8-year period.
2. Conversion from Pre-diabetes to Type 2 diabetes: Another study of men and women with prediabetes (fasting glucose between 100-125 mg/dL) found resistance training (1 hour thrice weekly) to reduce conversion to Type 2 diabetes by 65%!
3. High Cholesterol: A Study of more than 7300 men found that ~1 hour of resistance training per week was associated with a 32% lower risk of high cholesterol (equal to or greater than 240 mg/dL) over ~20 years of followup.
4. Quitting Smoking: A study funded by the National Cancer Institute found that men and women who engaged in two 1-hour sessions of resistance training over a 12-week smoking cessation program were 2x as likely to successfully quit than their non- weight lifting counterparts.

Dr. Michael Miller is Director, Center for Preventive Cardiology at the University of Maryland Medical Center in Baltimore.

**from “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease”