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Val Palamidy
Section 81760
Triglycerides and Cardiovascular Disease

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Triglycerides and Cardiovascular Disease
Introduction
Triglycerides, also known as triacylglycerols, is a type of fat found in the bodys
blood and in food from plants and animals. Its structure consists of a glycerol molecule
with three hydroxyl groups linked to the carboxyl groups of three fatty acids chains to
form ester bonds (1). Fatty acid chains can consists of small, medium and long, which can
range from having between 4-24 carbon atoms(1). The shape of triglycerides depends on
whether its compound is saturated or unsaturated. In saturated fat, its carbon chain does
not contain a carbon-carbon double bond allowing similar compounds to stack together to
form solids at room temperature such as animal fat(1). Unsaturated fats, consists of chains
of monounsaturated (one carbon-carbon double bond) and polyunsaturated (two or more
carbon-carbon double bonds) fatty acids(1). Since the structure of unsaturated fats makes
it difficult for compounds to stack together, at room temperature these fats exist as liquids
such as vegetable oil(1).
Body
Digestion of triglycerides first occurs by mastication in the mouth where salivary
glands release lingual lipase to break down triglycerides to form diglycerides and fatty
acids (2). The initial emulsion (chyme) is beneficial in increasing dietary lipid surface
area as it enters the stomach(2). Once in the stomach, gastric lipase only hydrolyzes 1030% of ingested triglycerides, while producing diglycerides and free fatty acids (2).
Together, lingual and gastric lipases from the oral cavity and stomach hydrolyze only
medium- and short-chain fatty acids to yield diglycerides(1). Undigested fat in the
stomach provides a high satiety value in which it delays the rate of the stomach in

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emptying its contents (1). Muscle contractions within the stomach causes the chyme,
created by a mixture of food and gastric juices, to pass through pyloric sphincter to enter
into the small intestine were most of the digestion and absorption occurs(1). The presence
of fat stimulates cholecystokinin (CCK) hormones to be released, which then stimulates
the gall bladder to release bile from the liver to emulsify fats(1). In addition to the bile,
pancreatic lipase enzymes are secreted to aid in breaking down triglycerides into
monoglycerides and fatty acids through the process of lipolysis(1). Absorption involves
the help of micelles by transporting monoglycerides and fatty acids, along with fatsoluble vitamins and cholesterol, to diffuse into enterocytes where they can be resynthesized to triglycerides(1). They are then packaged into chylomicrons, lipoproteins,
which specialize in transporting lipids throughout the body(1). Chylomicrons are then
transported to the lymphatic system for cellular absorption of triglycerides and returned
as chylomicron remnants back to the liver(1). The short and medium-chain fatty acids exit
into the portal blood and bind to albumin to be transported to the liver(1).
Not only do triglycerides contribute to the lipid bilayer membrane structure of a
cell but also use it as a source of energy. Consuming dietary fats provide twice as much
energy compared to carbohydrates and proteins. Although, if the body is consuming more
triglycerides than the body is burning, it is stored as body fat in the adipose tissue as
reserved energy(1). This energy is later used as fuel for the bodies during periods of
fasting.
Triglycerides are recognized as an important biomarker of cardiovascular disease
risk because of its association lipoprotein remnants that may promote atherosclerosis(4).
When lipoproteins remnants return to the liver, the intermediate-density lipoprotein (IDL)

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is converted to low-density lipoprotein (LDL) and transports cholesterol back to the cells.
Overtime, this can lead to a build up of plaque within the arteries and increases the risk of
cardiovascular disease.
Recommendations from the European Atherosclerosis Society (EAS) Consensus
Panel suggest that the basic lifestyle interventions should be applied to those that have
elevated triglycerides and are at risk with cardiovascular disease(5). Increasing physical
activity to at least 30 minutes of moderate activity, five days a week lowers triglycerides
by 20% and increases high-density lipoprotein (HDL) by 10%(5). For those at an
extremely high risk of cardiovascular disease, smoking and alcohol intake should be
avoided at all costs(5). Adopting a diet high in monosaturated and low saturated fatty
acids, and low-carbohydrates, while also avoiding refined sugar and fructose rich diets as
well(5). A calorie restriction diet should be applied to obese patients to promote weight
loss of at least 10% body weight(5). Losing weight decreases triglycerides by
approximately 6.6 mg/dL, for every 5 kilograms of weight lost(6). Medications, such as
niacin, fibrates, and fish oil are also used to treat high levels of triglycerides in addition to
the basic lifestyle interventions(3).
Conclusion
Atherosclerotic cardiovascular disease still remains the leading cause of death and
disability, affecting 13.2 millions Americans(4). Its also been established that both
elevated triglycerides and reduced HDL levels have an increased risk in cardiovascular
disease and many dietetic practices should focus on lowering these levels by encouraging
therapeutic lifestyle changes(5). Lipid profiles tests measures the levels of triglycerides,
total cholesterol, HDL (good cholesterol) and LDL (bad cholesterol)(7). It is

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recommended to aim triglyceride levels to below 150 mg/dL, for when levels are seen at
400 mg/dL and higher, other risks such as pancreatitis are taken into account(7). As a
health professional, its important to understand and develop an individualize plan for
each client wanting to improve their lipid profiles. Not everyone responds to diet and
exercise the same; therefore, clients should be seen on a frequent basis to ensure goals are
being maintained and that clients are educated about the health benefits of altering their
lifestyle.
Diagram

Exogenous and endogenous, are two pathways involved in the metabolism of

triglyceride-rich lipoproteins. Exogenous pathways are responsible for metabolizing

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dietary fat while endogenous pathways represent hepatic secretion of triglyceride-rich
particles(8).
References
1. Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism 6th edition.
Belmont, CA. Wadsworth, Cengage Learning. 2013. 137-165
2. Digestion and absorption of olive oil. Grasas Y Aceites [serial online]. January
2004;55(1):1-10. Available from: Academic Search Complete, Ipswich, MA.
Accessed October 6, 2013.
3.Triglcerides and Heart Disease. Harvard Heart Letter [serial online]. September
2000;11(1):1. Available from: Academic Search Complete, Ipswich, MA.
Accessed October 6, 2013.
4. Talayero B, Sacks F. The role of triglycerides in atherosclerosis. Current Cardiology
Reports [serial online]. December 2011;13(6):544-552. Available from:
MEDLINE, Ipswich, MA. Accessed October 13, 2013.
5. Chapman M, Ginsberg H, Watts G, et al. Triglyceride-rich lipoproteins and highdensity lipoprotein cholesterol in patients at high risk of cardiovascular disease:
evidence and guidance for management. European Heart Journal [serial online].
n.d.;32(11):1345-1361. Available from: Science Citation Index, Ipswich, MA.
Accessed October 13, 2013.
6. Singh A, Schwartzbard A, Gianos E, Berger J, Weintraub H. What should we do about
Hypertriglyceridemia in Coronary Artery Disease Patients?. Current Treatment
Options In Cardiovascular Medicine [serial online]. February 2013;15(1):104.

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7. Triglycerides may predict stroke. Harvard Health Letter [serial online]. June
2012;37(8):5. Available from: Academic Search Complete, Ipswich, MA.
Accessed October 13, 2013.
8. Gandotra P, Miller M. The role of triglycerides in cardiovascular risk. Current
Cardiology Reports [serial online]. November 2008;10(6):505-511. Available
from: MEDLINE, Ipswich, MA. Accessed October 13, 2013.