Triglycerides: What is normal?

In The Track Your Plaque program, we advocate decreasing triglycerides to 60 mg/dl or less.

That's the level of triglycerides that minimize the presence of triglyceride-containing undesirable lipoproteins causing plaque, such as small LDL, VLDL, and the after-eating persistence of IDL (intermediate-density lipoprotein, a bad player). (The enzyme, cholesteryl-ester transfer protein, or CETP, is responsible for exchanging one triglyceride molecule for one cholesterol molecule between HDL and other lipoprotein particles. Thus, an excess of triglyceride availability permits CETP to operate unrestrained, creating more undesirable lipoproteins. This was the basis for Pfizer's now defunct CETP inhibitor, torcetrapib.)

Of course, this triglyceride target is far below that of the conventional guidelines. The Adult Treatment Panel-III of the National Cholesterol Education Panel suggests a triglyceride level of 150 mg/dl is okay.

In my view, a level of 150 mg/dl is highly abnormal, permitting the persistence of multiple lipoprotein particles and virtually guarantees plaque growth. In short, triglycerides of 150 are awful.

Curious thing: Successful participants in our program, i.e., people who achieve desirable weight, reduce processed carbohydrate junk foods and saturated fat sources, and aim for the 60-60-60 targets for conventional lipids, commonly end up with triglyceride levels of 25-50 mg/dl.

We have seen many people drop their heart scan scores just by achieving a triglyceride level of 60 mg/dl or less. So achieving a lower level below 60 is not necessarily a requirement for coronary plaque regression.

But it makes me wonder if a triglycere level of 30s or 40s is the level for perfect health. These are levels ordinarily regarded as impossibly low. When colleagues see the numbers we readily and routinely achieve, they declare that the numbers are spurious, temporary, or just flukes. "No way you can do that all the time!"

This level also seems to, in virtually all cases, eliminate the triglyceride-containing undesirable lipoproteins small LDL, IDL, etc., and allow full conversion of HDL into the healthy, large fraction.

Should we move the Track Your Plaque triglyceride target to below 45 mg/dl or even lower? I don't think so, but it makes me wonder.

Comments (2) -

  • Emily

    11/29/2010 10:43:23 PM |

    interesting. i recently had my cholesterol levels checked and had triglyceride levels of 46, perfect? on the other hand, my ldl is 166, but this is from the standard test, not calcuated/measured the way you suggest. hdl is 73 and vldl 9, which i think is pretty low and good? i find this info confusing but am happy that my doctor recomended niacin and fish oil and cod liver oil rather then drugs.

  • Yvonne

    12/15/2010 8:23:58 AM |

    Just got results from cholesterol screening and Triglycerides are 32That sounds so low to me.  Hdl is 71 and Ldl is 173. I have been off of Lipitor for 6 months to see is I could bring down bad Ldl.  My doc wants me to go back on Lipitor (10 mgs).  Why are triglycerides are so low is a mystery.  They have been running 65-70 while I was on Lipitor.