Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Are Triglycerides And Lipoprotein Related?

Thursday, 01 July 2010 09:17 AM

Question: A recent blood analysis had my triglycerides at 244 and my very low lipoprotein at 49. Are these two test results related?"

Dr. Hibberd's Answer:

You are correct. They are not the same. The usual ratio however is 5-to-1, just as the normal values reflect.

The VLDL (very low-density lipoprotein ) particles are transport vehicles for your triglycerides (blood fats) in the bloodstream. Triglycerides are transported as chylomicrons (large lipoprotein particles that incorporate triglycerides and cholesterol) from the intestinal epithelial cell known as the exogenous transport system and well as VLDL particles synthesized in your liver known as the endogenous transport system.

An isolated elevation in plasma triglycerides indicates the concentrations of chylomicrons or VLDL are increased (and sometimes both are increased); hence, while your VLDL usually reasonably reflects your triglyceride levels, triglyceride levels incorporate chylomicron and VLDL levels in one reading.

The VLDL particles are a part of the "endogenous" transport system for triglycerides in our bodies. Our liver converts carbohydrate to fatty acids, chemically combines the fatty acids with glycerol to form triglycerides (tri-glycerides means three glycerol components added), and secretes the triglyceride into the bloodstream in the core of a very low density lipoprotein (VLDL). As the triglycerides are utilized, the VLDL particle is transformed to an IDL (intermediate density lipoprotein) and eventually is incorporated into the LDL (low density lipoprotein or bad cholesterol) in our bloodstream
The VLDL particles are large, and contain a form of apoprotein B (an identifiable surface protein) and are transported to tissue capillaries for breakdown and utilization. Apoprotein levels are likely to confuse you with interpretation, and have selective clinical significance. Their discussion has theoretical significance with limited practical application at present.

I suggest you interpret your triglyceride levels with your LDL and HDL levels and avoid overcomplicating your risk analysis with VLDL measurements and interpretation. Apoprotein levels are occasionally useful but not generally recommended except in special circumstances which is beyond the scope of this column.

Simplify your life. Concentrate on your LDL (bad cholesterol: the lower the better) readings and your HDL (good cholesterol readings: the higher the better) to properly interpret your risks. THEN review your triglyceride readings. Remember triglyceride readings flux and respond to the presence of other disorders such as diabetes mellitus and are to be drawn after a 12-hour fast to be accurately interpreted. If there is concern about the best treatment options or your specific lipoprotein subtype, a lipoprotein electrophoresis (a simple blood test) will help characterize your lipoprotein disorder and perhaps provide further insight into your condition and its causes.

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