If triglycerides are a more significant indicator of cardiovascular disease (CVD) risk in women than in men, is it appropriate to treat even if LDL is normal? If so, what is the best medication to use? — Joan A Peters-Gilmartin, PA-C, Mashpee, Mass.

I take elevated triglycerides seriously regardless of gender, especially when the patient exhibits such global markers of metabolic syndrome as hypertension, low HDL, impaired glucose tolerance/diabetes mellitus and/or central obesity.

The 2004 update to the National Cholesterol Education Program cholesterol guidelines states that metabolic syndrome automatically puts the patient at very high risk of coronary artery disease. That said, the primary goal remains to lower LDL levels, in this case, to <70 mg/dL whenever possible with the use of statins.

Once the effect of statins is seen, combination therapy utilizing fenofibrate or prescription fish oil can be effective at lowering triglycerides. The only time triglycerides should be the primary focus is when the level is >500 mg/dL, putting the patient in danger of pancreatitis. Please don’t forget what a difference lifestyle changes can make, especially reducing consumption of simple carbohydrates and increasing exercise. — Rebecca H. Bryan, APRN, CNP (157-1)

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