What are triglycerides and when should I be worried about mine?

Triglycerides are blood lipids (fat molecules) that reflect recent carbohydrate and fat intake, alcohol consumption, and insulin resistance, normal fasting triglycerides are below 150 mg/dL, borderline high is 150–199 mg/dL, high is 200–499 mg/dL (associated with increased cardiovascular risk), and very high above 500 mg/dL (associated with pancreatitis risk), elevated fasting triglycerides are often the first lipid abnormality in men developing insulin resistance and metabolic syndrome (Miller et al., Circulation, 2011).

For cardiologists, elevated triglycerides matter primarily because: (1) they are part of the atherogenic dyslipidemia pattern (high triglycerides + low HDL + elevated ApoB despite normal LDL-C) that most strongly predicts cardiovascular events in insulin-resistant men; and (2) triglyceride-rich lipoproteins (VLDL, remnant cholesterol) are independently atherogenic beyond their contribution to ApoB. Fasting triglycerides above 150 mg/dL in a man over 40 is a metabolic warning flag that warrants further evaluation.

Honesty Scale: Solid (1) for triglyceride levels as metabolic risk markers. Solid (1) for fasting triglycerides above 150 mg/dL as the appropriate clinical concern threshold.

What to do: If your fasting triglycerides are above 150 mg/dL, the primary interventions: reduce refined carbohydrates and alcohol (the two most powerful triglyceride drivers), add fish oil at 2–4 g/day EPA+DHA, and improve insulin sensitivity through exercise. If triglycerides remain above 200 mg/dL despite these changes, a cardiologist's evaluation including ApoB and fasting insulin is warranted.

For the full picture, read The ApoB/Lp(a)/Lipids Deep Dive