Does high fasting triglycerides cause heart disease?

In this article, we’ll explore the role of fasting triglycerides, their connection to cardiovascular health, what optimal levels are and why aiming for those levels is essential.

Fasting triglycerides are an important marker of cardiovascular health, often overlooked in favour of cholesterol levels. These fats, circulating in the blood, provide energy for the body but can become harmful when present in excess.

Elevated fasting triglyceride levels are associated with an increased risk of heart disease, atherosclerosis, and metabolic syndrome. Research shows that managing triglyceride levels can significantly reduce cardiovascular risk, making them a critical focus in preventative healthcare.

What is the Fasting Triglyceride Test?

Triglycerides are a type of fat found in the blood, primarily derived from dietary fats and the conversion of excess carbohydrates. After eating, the body converts excess calories into triglycerides, storing them in fat cells for energy between meals. When fasting, triglycerides in the blood provide a clearer picture of the body’s metabolic state, as they reflect how effectively the body manages fat storage and utilisation.

Fasting triglycerides are measured through a simple blood test, typically requiring at least 8 hours without food or drink (except water) to ensure accurate results. Elevated fasting triglycerides are not just a standalone risk factor but also a marker of other underlying metabolic issues, such as insulin resistance, which significantly impacts cardiovascular health.

What is the Connection Between Triglycerides and Cardiovascular Health?

High fasting triglycerides are directly linked to an increased risk of cardiovascular disease.

Excess triglycerides can contribute to the development of atherosclerosis, where fatty deposits build up in the walls of arteries, narrowing them and restricting blood flow. This process increases the risk of heart attacks and strokes.

Elevated triglycerides are also a hallmark of metabolic syndrome, a cluster of conditions that include abdominal obesity, high blood pressure, and insulin resistance. Together, these factors amplify the risk of heart disease and type 2 diabetes. Research indicates that people with fasting triglycerides above 1.7 mmol/L (150 mg/dL) are more likely to experience cardiovascular events, especially when combined with other risk factors like imbalanced cholesterol levels, raised inflammatory markers, high insulin, Lp (a) and so forth.

In addition to atherosclerosis, high triglycerides can exacerbate inflammation in blood vessels, compounding vascular damage. Studies have highlighted the role of elevated triglycerides in promoting a pro-inflammatory environment, making their management critical for reducing cardiovascular risk and improving overall metabolic health.

It is critical to manage anything that could be contributing to a chronic state of inflammation or oxidative stress, as these two factors are at the core of cardiovascular disease development.

What are the Normal and Optimal Triglyceride Ranges?

Fasting triglycerides are typically measured in millimoles per litre (mmol/L) here in the UK, with ranges typically categorised as follows:

• Normal Range: Less than 1.7 mmol/L (150 mg/dL).
• Borderline High: 1.7–2.2 mmol/L (150–199 mg/dL).
• High: 2.3–5.6 mmol/L (200–499 mg/dL).
• Very High: Above 5.6 mmol/L (500 mg/dL).

While the “normal” range of less than 1.7 mmol/L is widely used, research increasingly supports aiming for an optimal range of 0.5–1.0 mmol/L to better protect cardiovascular health. Levels within this range are associated with lower risks of atherosclerosis, heart attacks, and strokes, as well as improved metabolic health.

Maintaining fasting triglycerides in the lower end of the spectrum not only reduces the direct risks associated with elevated levels but also indicates better overall metabolic function.

Elevated triglycerides often reflect poor fat metabolism, insulin resistance, or an unhealthy diet, issues that can be addressed with targeted lifestyle changes.

For individuals with triglyceride levels above 1.7 mmol/L, even modest reductions can significantly improve heart health. Achieving an optimal range often involves dietary adjustments, increased physical activity, and improving body composition, which together promote a healthier lipid (fat) profile, lowers inflammation, reverses insulin resistance and therefore reduces cardiovascular risk.

What Causes Elevated Fasting Triglycerides

Several factors can lead to elevated fasting triglycerides, many of which are closely tied to lifestyle and metabolic health. Identifying these causes is the first step toward managing and reducing triglyceride levels effectively:

Dietary Factors

A diet high in refined carbohydrates, added sugars, and excessive consumption of fats is a primary contributor to elevated triglycerides.
Excessive Alcohol Consumption: Alcohol is processed in the liver and converted into triglycerides. Drinking too much alcohol, even occasionally, can significantly raise triglyceride levels.

Obesity

Excess body fat, particularly around the abdomen (visceral fat), is closely linked to higher triglycerides.

Sedentary Lifestyle

A lack of physical activity can lead to reduced fat and carbohydrate metabolism and higher circulating triglycerides.

Genetics

Familial hypertriglyceridemia, a genetic condition, can predispose individuals to elevated triglyceride levels, making management more challenging.

Chronic Conditions

Diabetes, kidney disease, and hypothyroidism can also contribute to higher triglyceride levels by impairing normal fat metabolism.

Understanding these causes allows for targeted interventions, with lifestyle medicine offering significant potential to address and manage elevated triglycerides effectively and naturally.

Can you lower fasting triglycerides naturally?

Lowering fasting triglycerides and achieving the optimal range of 0.5–1.0 mmol/L is possible through lifestyle changes that address the root causes of elevation. Here are key strategies:

Nutrition

1. Reduce the intake of refined carbohydrates and added sugars, which directly increase triglyceride levels.
2. Incorporate healthy fats, such as those found in fatty fish (rich in omega-3s), nuts, seeds, and olive oil, to lower triglycerides and promote heart health.
3. Increase dietary fibre from vegetables, fruits, legumes, and whole grains to slow fat absorption and improve lipid metabolism.
4. Limit saturated fats and eliminate trans fats, which are commonly found in processed foods.
5. If excessive body fat is an issue, creating a calorie deficit with a change in your dietary habits will help you reduce body fat and lower your triglyceride levels.

Physical Activity

Regular exercise significantly lowers triglycerides by improving the body’s ability to metabolise fats. Aim for at least 150 minutes of moderate-intensity activity per week. This could be a mix of cardio and weight training.

In addition, aim to get your daily movement levels up. This could include adding in movement snacks into your day where you exercise for 1-3mins every 1-2hours. Alternatively building in more steps and regular walking breaks into your day.

Improve Body Composition

Losing even a small percentage of body weight (5–10%) can result in significant reductions in triglyceride levels, especially for those with overweight or obesity.

The target should be predominantly fat loss, while trying to maintain as much muscle as possible or even build muscle in the process through appropriate types of training.

Alcohol Moderation

Limit alcohol intake to occasional consumption or eliminate it altogether if triglycerides are significantly elevated.

Stress Management

Chronic stress can increase triglycerides indirectly by promoting unhealthy eating habits.

Find what works best for you in terms of helping to manage stress. This could be things like breathwork, talking a walk while listening to a funny podcast, doing talking therapy, spending more time with family and friends etc.

Supplementation

Whilst this is not the first line of management, some supplements have been shown to be beneficial in lowering triglyceride levels, these include:

1. Fish Oil
2. Niacin / vitamin B3 – Can cause a flushing side effect, so not always tolerated well as a treatment strategy.
3. Red Yeast Rice (Acts in a similar way to statin medications, so I use sparingly and with caution).
4. Beta glucans – A type of dietary fibre derived from cereals, seaweed, bacteria and fungi.
5. L-Carnitine – May help to support cellular fat metabolism.

Adopting some of the above strategies not only helps lower fasting triglycerides but also improves overall cardiovascular and metabolic health. Making gradual, sustainable changes is key to long-term success.

Conclusion

Fasting triglycerides are a vital marker of cardiovascular and metabolic health, offering insight into how effectively the body processes and stores fat. While elevated triglycerides are a significant risk factor for atherosclerosis, heart disease, and metabolic syndrome, they are also highly responsive to lifestyle interventions.

Striving for an optimal range of 0.5–1.0 mmol/L can help you reduce inflammation, improve vascular health, and lower the risk of cardiovascular events. It is also a sign you are reversing insulin resistance and type 2 diabetes risk.

By addressing common causes such as poor diet, sedentary behaviour, and excess weight, you can make meaningful changes to your triglyceride levels.

A lifestyle medicine approach, including a balanced, anti-inflammatory diet, regular physical activity, healthy weight management, and stress reduction offers a powerful, sustainable way to achieve and maintain optimal triglyceride levels.

Monitoring fasting triglycerides as part of a comprehensive cardiovascular or general health assessment ensures that potential risks are identified early, allowing for proactive management.

With the right strategies, it’s possible to not only lower triglycerides but also promote long-term cardiovascular health and overall well-being.

If you are interested in learning more about improving your cardiovascular health, check out my FREE 20 min training on ‘how to beat the cardiovascular clock’.