Triglycerides' effect on stroke risk prompts warning

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On Feb. 2, Dr. Sylvia Wassertheil-Smoller of the Albert Einstein College of Medicine reported that the strongest risk factor for the common type of strokes in older women is high levels of triglycerides -- a greater risk than cholesterol.

In everyday language a triglyceride is a kind of fat found in the blood. In general, when a test is done for cholesterol the report also shows the triglyceride level.

For years the focus has been on cholesterol levels, especially LDL which is known as the "bad" cholesterol. If that is too high, a person is considered at risk for hardening of the arteries, or arteriosclerosis, with damage to the heart, kidneys, brain, etc.

Although a previous study in Denmark published in the April 2011 Annals of Neurology linked the higher the levels of triglycerides to higher risk of stroke, it was not as convincing as the one reported in February.

The Denmark study was done on 7,579 women and 6,372 men followed for up to 33 years, whereas the U.S. government study reported in February followed 90,000 postmenopausal women for 15 years.

In the June 2012 issue of the Harvard Health Letter, Dr. Jo Ann Manson, one of the authors of the February 2012 study and a Harvard Medical School professor, pointed out that women with the highest levels of triglycerides were 56 percent more likely to have an ischemic stroke than those with the lower levels.

An ischemic stroke is caused by arteriosclerosis. Ninety percent of strokes are ischemic. She indicated the goal should be to get the level of triglycerides below 150.

According to the Cleveland Clinic, one of the top 10 clinics in the U.S., middle-aged women have about twice as many strokes as middle-aged men.

Although medications can be given to lower the level she indicated the best thing to do is lifestyle changes.

Losing weight "will help tremendously" as will decreasing refined carbohydrates and increasing fruits, vegetables, and whole grains.

Other things that women can do is to eat fish, and if taking estrogens by mouth stop it or switch to a patch and reducing alcohol to no more than one drink daily.

According to the Mayo Clinic alcohol increases triglyceride levels so the more you drink the higher your triglyceride levels go. They recommend no more than one drink per day for women and two for men but add that since even moderate use can elevate the levels to abstain from alcohol is better.

Besides elevating the triglyceride levels alcohol increases the risk of breast cancer. The American Cancer Society in a website discussing the risk for breast cancer indicates it is clear that alcohol increases the risk and that the risk increases with the amount consumed.

The increase in women who have one drink a day is very small.

In the March 2007 American Journal of Epidemiology, a study whose authors include the previously mentioned JoAnn Manson stated moderate alcohol consumption increases the breast cancer risk.

It looks like with the new information about the risks of stroke a woman will now have to decide whether the claimed benefit to the heart from the moderate use of alcohol is outweighed by the risk of a stroke or breast cancer.

There is a need for clarification for two of my recent columns. At the end of the June 15 column these words "improve your mood, stamina, and sex life" should have been in quotation marks since they were quoted from a Mayo Clinic website. In case you didn't happen to read that article here is the website: www.mayoclinic.com/health/exercise/HQ01676.

The June 22 column tells about a health problem from the use of statins. After that appeared it was brought to my attention that some folks didn't know what statins were.

They are drugs that have been used for years to help lower cholesterol. More folks may have been familiar with the trade names. Simvastatin is sold as Zocor and pravastatin as Pravachol. One of the earliest statins was lovastatin also known as Mevacor or Altocor or Altoprev.

Dr. Don Casebolt of College Place is a retired physician who is passionate about preventive medicine. He spent 4 years as a medical officer in the U.S. Navy, the last 21/2 years as a flight surgeon. He also worked on the Navajo Reservation for 22 years.

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