High Triglycerides Versus Bad Cholesterol: Which Is Worse?

 Though you may know the difference between bad cholesterol and good cholesterol, you may not know that your triglycerides, a type of fat found in your blood, are equally important to your heart health. When levels are too high, fatty deposits are more likely to build up in the arteries, which raises the risk of heart problems.

In fact, high triglycerides are as dangerous as bad cholesterol when it comes to this risk.

“I now get asked about triglycerides a couple of times a week,” says Luke Laffin, MD, codirector of the center for blood pressure disorders at the Cleveland Clinic. People ask him how the fats are related to heart disease, and how they should reduce them.

A study published in the June 2020 issue of Cardiology and Therapy analyzed 9,593 people from 2007 to 2014 and found that high triglycerides may be a problem for one-quarter of all Americans, and may be higher if they are being treated with statins or have diabetes or atherosclerotic cardiovascular disease.

The good news is that the Centers for Disease Control and Prevention (CDC) says this marks a decline from the 33 percent of people with high triglycerides in the United States in 2001–2004. The rates dropped for both men and women, seniors ages 60 and over, and for people who are overweight and obese.

Part of this decline may have been caused by more people taking cholesterol-lowering medications like statins, such as atorvastatin or rosuvastatin. A study in the January 2019 Journal of the American Heart Association found that 60 percent of people who have had a heart attack and fewer than 40 percent of those without a history of heart attack took their statin medication regularly. The study considers this number low, but it is higher than that reported in a December 2014 National Center for Health Statistics data brief, which found that only 28 percent of adults age 40 and older used a cholesterol-lowering medication.

What’s more, prescription-strength omega-3 fatty acid medications like Lovaza and Vascepa seem to be working. According to a study published in August 2019 in the American Heart Association journal Circulation, prescription omega-3 fatty acid, in a dose of 4 grams (g) daily, effectively lowered triglyceride levels by 20 to 30 percent in patients who already required triglyceride-reducing drugs.

High Triglycerides and Cholesterol Means High Risk 

One of the common reasons for high triglycerides is a high-fat diet. When you eat fatty calories, the fat levels in your blood go up. The body also makes triglycerides from the carbohydrates you eat and may send triglycerides to fat cells. 

Optimally, your triglyceride level should be less than 150 milligrams per deciliter (mg/dL); borderline levels are up to 199 mg/dL; over 200 mg/dL is considered high; and over 500 mg/dL is very high, according to the CDC.

But triglycerides are not exactly the same as other cholesterol levels. High-density lipoprotein (HDL) or the “good cholesterol” keeps cholesterol from building up inside your blood vessels and returns it to your liver. Low-density lipoprotein (LDL) or the “bad cholesterol” is the type that forms plaques inside blood vessels, increasing the risk of heart problems. 

“There's not as strong an association with increased risk for strokes as heart attacks as [there is for] LDL cholesterol,” says Dr. Laffin, “But with triglycerides, it's definitely there.”

You ideally want your total cholesterol to be below 200 mg/dL, but you also need to know the breakdown of your cholesterol levels:

• Your LDL cholesterol level should be below 100 mg/dL — the lower the better.
• Your HDL cholesterol level should be above 60 mg/dL — the higher the better.

Getting Control of High Triglycerides

As with many high cholesterol cases, a clinical review published in the November 2019 European Heart Journal found that people with high triglycerides tend to have poor lifestyle habits, such as a high-fat diet, inadequate exercise, and high alcohol consumption. 

While medications like statins can help control high triglyceride levels, according to the American Heart Association, healthy lifestyle changes to counter those bad habits and control high triglycerides are even more important than medication.

Here are some of those choices.

Maintain a Healthy Body Weight

Besides heart disease, triglycerides can also lead to other complications, many of which can be prevented with a healthy body mass index (BMI). While genetics plays a part in each person’s ability to stay at the recommended BMI of 25 or lower, Laffin says that people should be concerned if they reach obesity levels of 30 or higher. 

“Really high triglyceride levels typically can occur when you're obese,” he says. “That’s one of the risk factors, particularly if you have diabetes.”

Eat a Healthy Diet

“The biggest thing that people can do is watch what they eat,” says Laffin, who puts patients on a triglyceride-lowering diet that includes nonstarchy vegetables, limited sugar, and lean proteins. 

The Cleveland Clinic recommends sugar-free beverages, fresh fruit with no added sugar, whole grains, and swapping out butter and coconut oil for extra-virgin olive oil. 

Get Regular Exercise

A regular exercise routine, like walking, jogging, or cycling, tends to reduce triglyceride levels. As with bad cholesterol, exercise will lower cardiovascular risk. 

A small study published in the January 2019 Clinical Cardiology found that eight weeks of aerobic exercises reduced triglycerides in patients with heart disease, along with other bad cholesterol levels. Additionally, the American College of Cardiology says that physical activity can reduce triglyceride levels up to 30 percent, but the regimen needs to be consistent.

Laffin recommends 150 minutes a week, which is just over 20 minutes of moderate exercise a day. 

Stop Drinking Alcohol 

You’ve probably heard that a glass of wine with dinner is okay, but Laffin recommends cutting out all alcohol if you have high triglycerides. 

The ill effects of booze are partly due to how alcohol breaks down in your liver, according to Heart UK. Triglycerides and cholesterol are produced when the liver processes alcohol, and they're released into the blood.  

Quit Smoking

It’s perhaps not surprising that smokers often have higher levels of triglycerides in their system, as research shows. But Laffin says the two are not necessarily connected. 

“Smoking is not good for cardiovascular health, so we don't recommend it,” he says. “But it doesn’t really have a huge impact on triglycerides.”