The link between triglycerides and cardiovascular disease is still under discussion. However, growing evidence suggests that high triglyceride levels in the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood may contribute, along with other factors, to the development of certain heart conditions.
What are triglycerides?
Triglycerides are a type of fat (or lipid) that the body uses as a source of energy. Some come directly from food, while others are produced by the liver from excess sugar or alcohol.
Once formed, these fats must circulate in the bloodstream to be used or stored in cells.
Trucks and taxis for transport
Just like cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >>, which circulates in the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood using “taxi” vehicles called LDL and HDL lipoproteins, triglycerides also need to be carried by specialized particles.
Two main types handle this transport: chylomicrons, which are very large and comparable to trucks, and VLDL (very low-density lipoproteins), which are smaller.
Fats from food
The fats we eat are broken down into triglycerides during digestion in the intestine. These triglycerides are then packed into large chylomicrons, which carry them to the liver.
From the liver to the cells
From the liver, triglycerides are released into the bloodstream with the help of VLDL, these roomier taxisLipid transport proteins, such as lipoproteins, act as “taxis” in the blood, transporting cholesterol and other fats to and from cells. However, when these lipoproteins are imbalanced or dysfunctional, they can contribute to the formation of cholesterol >>.
Once they reach their destination, the triglycerides can exit their vehicle and enter the cells, where they will be used or stored.
Delivering triglycerides
As the triglycerides are unloaded, their carriers shrink in size. It’s like a bunch of grapes losing its fruit one by one—the remaining stem becomes much smaller.
In the same way, once most of their contents are delivered, chylomicrons leave behind remnants, and VLDL particles are transformed into smaller fragments called IDL (intermediate-density lipoproteins).
These leftovers may then be used as energy for muscles or stored in body fat.
The role of cholesterol in cardiovascular disease
For many years, efforts in heart disease prevention have focused on lowering cholesterol, especially LDL—commonly referred to as “bad cholesterol”. High levels of LDL are clearly associated with a greater risk of heart attack or stroke.
Triglycerides: a long-overlooked factor
Triglycerides, another type of fat circulating in the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood, were long thought to be less important than cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >>.
However, they are now gaining attention. High triglyceride levels (a condition known as hypertriglyceridemia) may also play a role in heart disease, especially when combined with other risk factors.
How do triglycerides contribute to plaque formation?
At first, these transporters are too large to enter the artery wall. But once they have delivered their load of triglycerides into the cells, they become smaller. These lighter versions — nearly empty taxisLipid transport proteins, such as lipoproteins, act as “taxis” in the blood, transporting cholesterol and other fats to and from cells. However, when these lipoproteins are imbalanced or dysfunctional, they can contribute to the formation of cholesterol >> and trucks — can then cross the arterial wall.
Inside, they are engulfed by specialized cells called macrophages, whose job is to clean up. These cells fill up with fat, grow larger, and are then called foam cells. Because they become too big to leave, they remain trapped within the artery wall.
Over time, these foam cells eventually die and release their fatty contents, triggering an inflammatory reaction. More cells are then called in, and this is how a fatty plaque begins to form in the artery.
Recommended reading: Atheromatous Plaque
A debated role
This process supports the idea that triglycerides are atherogenic—that is, they contribute to the development and progression of plaque in the arteries.
Elevated triglyceride levels are associated with a greater risk of coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease.
Why does this remain controversial?
The debate stems from the fact that the shrunken carriers of triglycerides (the emptied taxisLipid transport proteins, such as lipoproteins, act as “taxis” in the blood, transporting cholesterol and other fats to and from cells. However, when these lipoproteins are imbalanced or dysfunctional, they can contribute to the formation of cholesterol >> and trucks) still contain cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> when they enter the artery wall.
Some experts believe it’s actually this leftover cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >>, not the triglycerides themselves, that drives plaque buildup. It’s difficult to distinguish between the two, which is why the exact role of triglycerides in heart disease is still being discussed.
Other contributing factors
LDL transporters—linked with bad cholesterol—can themselves promote plaque formation.
Just like cars on the road can release pollution, certain proteinsProteins are fundamental components manufactured by the cells of our body. They play an essential role in many biological functions, acting as hormones, antibodies, and even cholesterol transporters, among others. >> found in these lipoproteins may also trigger inflammation, further increasing cardiovascular risk.
Researchers are exploring whether reducing these proteinsProteins are fundamental components manufactured by the cells of our body. They play an essential role in many biological functions, acting as hormones, antibodies, and even cholesterol transporters, among others. >> could become a new therapeutic strategy to improve heart health.
Why lowering high triglycerides is still recommended
Even if the role of triglycerides is not fully settled, lowering high levels remains important. Triglyceride levels can, to some extent, help predict the risk of dying from heart disease in the short or long term.
Ongoing medical research may soon clarify whether triglycerides are a target for treatment in their own right.
How to lower high triglyceride levels
The first step is improving lifestyle habits. A balanced diet, regular physical activity, and limiting alcohol intake are all known to help lower triglycerides.
Recommended reading: Healthy Lifestyle Habits
When necessary, medication may be used. Depending on the clinical situation, options include statins, fibrates, omega-3 fatty acids, or niacin.
No specific treatment yet
There is currently no medication designed specifically to lower triglycerides with the direct goal of preventing heart disease. Interest in developing such treatments remains limited, though some existing therapies are used when needed.
Looking ahead
Interest in the role of triglycerides continues to grow. As understanding improves, and with better awareness and targeted treatment options, this long-standing debate may one day be resolved—leading to improved prevention of cardiovascular disease.
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