What Causes High Triglyceride Levels And What Are Safe Treatments?

My brother recently went in for his physical and was told he had a triglyceride level of 1496 and a cholesterol level of 330. I know this is high, but when he told me the medication that was prescribed for this I became concerned. His doctor prescribed 20mg of zocar a day, but also 60mg of gemfibrozil twice a day for three months.

I am very concerned about the mix of these two drugs in the amounts he is to take for such a long period. He also drinks beer on the weekends, which I am afaid will add to the toxic effects that can cause severe damage to his liver. Should he seek another opinion?

Your brother has quite impressive increases in both his cholesterol and triglyceride levels. Cholesterol and triglycerides are both fats that circulate in the blood. The cholesterol count you mentioned is almost certainly the total cholesterol, which is made up of several components: principally, low density lipoprotein cholesterol (LDL) and high density lipoprotein cholesterol (HDL). HDL is often referred to as good cholesterol, since a high level seems to protect someone against the heart disease caused by a high LDL level.

We usually consider total cholesterol to be high if it is above 200mg/dL, and triglycerides if also above 200mg/dL. There are several genetic causes of high fat levels in the blood, some of which involve mutations of a single gene and will be present in many members of a family. Much more common, though, are high levels due to polygenic hypercholesterolemia, that is high levels of fats in the blood due to a complicated interaction between a genetic tendency and environmental factors, such as diet.

From the facts given about your brother, I cannot say which type of problem he has, but I can speculate that he is at high risk of developing serious coronary artery, or heart, disease. It would be important to know his age, whether he is overweight, has diabetes or hypothyroidism, and what his LDL and HDL levels are. Many people with this level of cholesterol and triglycerides have a low HDL, which greatly increases the risk of heart disease. His triglycerides are almost to the level where he may also be subject to acute pancreatitis, which is a severe, occasionally fatal inflammation of the pancreas.

In someone with a genetic tendency toward high triglyceride levels, these numbers may be greatly increased by alcohol, hypothyroidism, and diabetes. I would be much more concerned that your brother’s beer drinking is contributing to the problem, rather than about the side effects of the drugs on his liver. Simvastatin (Zocor) can cause liver damage and has to be watched carefully in heavy drinkers, but gemfibrozil (Lopid) does not produce severe liver toxicity. The combination of simvastatin and gemfibrozil can cause a severe degeneration of muscle cells, sometimes severe enough to lead to kidney failure. For this reason, the two drugs are not frequently used together, except in someone who has just the combination of high lipids as your brother.

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