High Triglycerides.

Q. I have very high triglycerides (600+) and I am 47. I also have very low good cholesterol. My doctor put me on Lipitor and I have made some life style changes, but what else should I be doing? What kind of preventative tests can I ask my doctor about? I am having a blood test next week. What about testing my arteries?

A.As you know, there are four different major types of lipids in the blood. One type is the triglycerides, another type is the cholesterol. Cholesterol itself is usually split into two types, the "good cholesterol" (or HDL) and the "bad cholesterol" (or LDL). The most critical elements for heart disease are a high LDL and a low HDL cholesterol.

The importance of triglycerides has remained controversial, though most people consider that very high triglycerides such as you are experiencing confers some risk. For this reason it is appropriate that your physician put you on medication to treat your lipid abnormality and suggested that you make some lifestyle changes. The National Heart, Lung, and Blood Institute has a lot of information for consumers on lipids (http://www.nhlbi.nih.gov/index.htm).

The key things that you need to do are to make sure your diabetes (if you have diabetes) is under very good control, that you don't drink alcohol excessively, that you try to maintain your weight, and that you exercise. There are no preventive tests per se (tests don't prevent, they only find things early). You may be referring to screening tests, or tests that find things early, and one possibility is an exercise stress test to see if you have significant hardening of the arteries. This test is not routinely recommended, even for a person with abnormal blood lipids, but it is not an unreasonable test to obtain. A more definitive test is an angiogram. This is such "a test of your arteries," but in my opinion it is far too invasive and far too dangerous to recommend without having an abnormal stress test or without having symptoms.