How important is my triglyceride level?
Your triglyceride level is a serious risk factor. Always assess it together with your HDL cholesterol, blood sugar and waist circumference. Lifestyle changes alone can already make a significant difference.
Triglycerides are fats in your blood. The European lipid guidelines (ESC/EAS 2019) explicitly recognise them as a risk factor alongside the better-known LDL cholesterol. They are therefore not a minor detail, but a fully fledged component of your cardiovascular health1.
High triglycerides increase the risk of cardiovascular disease, even in people who are already taking statins and have substantially lowered their LDL as a result. This is known as 'residual risk'. Triglyceride-rich particles likely play a causal role in this. In statin users with high triglycerides, EPA, a specific omega-3 fatty acid found in fish oil, was shown to reduce both triglyceride levels and the number of cardiovascular events2.
Your triglyceride level becomes even more informative when set against your HDL cholesterol. That ratio is called the AIP (Atherogenic Index of Plasma). People in the highest AIP group had a 22% greater chance of cardiovascular disease than those in the lowest group (HR 1.22). A high AIP is also associated with metabolic syndrome: a combination of abdominal fat, high blood sugar and high blood pressure3.
Triglycerides also form the basis of the TyG index, a measure of insulin resistance that combines triglycerides and blood sugar. A higher TyG index is associated with an 18% greater chance of cardiovascular disease over nine years4. Combining the TyG index with a large amount of abdominal fat increases that risk further: a 75% greater chance compared with the reference group5. Notably, people with a lot of abdominal fat but a low TyG index appeared to have the highest risk of all (HR 1.87). Triglycerides therefore never stand alone. The combination of high triglyceride-glucose values with physical frailty was also associated with a sharply elevated risk of cardiovascular disease and stroke6,7.
Lowering triglycerides through lifestyle changes is the best first step: less sugar, alcohol and refined carbohydrates, and more physical activity. If levels remain high and other risk factors are also present, medication-based support, such as EPA in statin users, is an option worth discussing with your doctor.
All claims are based on observational studies and review articles (not randomised trials for most outcomes). The associations are statistically robust but largely associative in nature, not proven causal, with the exception of triglyceride-rich lipoproteins for which growing causal evidence exists (PMID 33257928). The ESC/EAS guideline (PMID 31504418) provides stronger normative evidence. None of the studies demonstrate direct harm from treatment.