Please comment on triglycerides as the “forgotten lipid.” There is so much emphasis on HDL and LDL levels. Should clinicians be looking more closely at triglyceride levels as predictors of heart disease?
—JOCELYN HOOK, MPAS, PA-C, Swoyersville, Pa. 

There is no clear evidence relating isolated triglyceride elevations and coronary artery disease. As a general guideline, however, a normal triglyceride level is <150 mg/dL. A triglyceride level of 200-350 is elevated, 351-499 is high. When to intervene will vary with the practitioner. I would monitor anyone with above-normal triglycerides (i.e., >150) and encourage lifestyle changes, diet modification, limitation of alcohol, and increased consumption of omega-3 fatty acids. Pharmacologic therapy should begin once other efforts have failed and the level is increasing. A fasting triglyceride level >500 carries with it a risk of pancreatitis. Each patient should be assessed independently to determine whether treating the elevated triglycerides outweighs the risks. Patients who are taking statins and suffering adverse effects can be offered niacin or a fibrate.
—Debra Kleinschmidt, PhD, PA