CME/CE: Recent Trends in Triglycerides

CME/CE: Recent Trends in Triglycerides
Author Information (click to view)

Margaret D. Carroll, MSPH

Survey Statistician
Division of Health and Nutrition Examination Surveys
National Center for Health Statistics
Centers for Disease Control & Prevention

Margaret D. Carroll, MSPH, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss recent trends in the percentage of adults aged 20 and over in the United States with elevated triglyceride level.

Method of Participation(click to view)

Release Date: 01/19/2017

Expiration Date: 01/19/2018

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwJan0417.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Physician Assistants
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing
AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Margaret D. Carroll, MSPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Margaret D. Carroll, MSPH (click to view)

Margaret D. Carroll, MSPH

Survey Statistician
Division of Health and Nutrition Examination Surveys
National Center for Health Statistics
Centers for Disease Control & Prevention

Margaret D. Carroll, MSPH, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

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Triglyceride levels among Americans appear to have dropped significantly in the past decade. Despite positive trends, continued efforts are needed to improve the adoption of several treatments and lifestyle modifications to further reduce triglyceride levels.
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Studies have shown that elevated triglyceride levels can increase risks for cardiovascular disease (CVD), stroke, and premature cardiovascular death. The American Heart Association also notes that high levels of triglycerides have been linked to type 2 diabetes and fatty liver disease. For adults with elevated triglycerides, experts have recommended several therapeutic lifestyle changes, including:

  • Increased physical activity.
  • Weight loss.
  • Optimal nutrition-related practices.
  • Smoking cessation.

“These lifestyle modifications can be very effective in lowering triglyceride levels in adults,” says Margaret D. Carroll, MSPH. Studies also suggest that medications like statins, omega-3 fatty acids, and other therapies may be helpful in lowering triglyceride levels.

 

A Look Across Time

In an NCHS Data Brief, Carroll and colleagues examined recent trends in the percentage of adults aged 20 and over in the United States with elevated triglyceride levels, which was defined as 150 mg/dL or higher. The authors examined data from the National Health and Nutrition Examination Surveys (NHANES) 2001–2004, 2005–2008, and 2009–2012. NHANES provides cross-sectional surveys that are designed to monitor the health and nutritional status of the non-institutionalized U.S. population.

Overall, triglyceride levels have dropped significantly across many demographic groups in the past decade, including both men and women, according to study results (Figure).

The percentage of all adults aged 20 and over with elevated triglyceride decreased from about 33% during 2001–2004 to approximately 25% during 2009–2012. Triglyceride levels also declined in overweight and obese men and women throughout the study period.

 

Older Adults

Among people aged 60 and older, large decreases were seen in the percent of people with elevated triglyceride levels. For men in this age group, there was a decrease from nearly 40% in 2001-2004 to nearly 25% in 2009-2012. In women 60 years and older, over 44% had high triglyceride in 2001-2004, but this figure dropped to about 31% in 2009-2012.

For adults aged 40 to 59, a decreasing trend was seen in men and women from 2001–2004 to 2009–2012. For adults aged 20 to 39, the percentage of men with elevated triglycerides did not change significantly, but notable changes were seen among women in this age range. The percentage of women in this youngest age group with elevated triglycerides declined from nearly 22% during 2001–2004 to slightly less than 15% during 2009–2012.

 

Ethnic Groups

“Levels of elevated triglyceride levels dropped from about 40% to 28% in Mexican-American women during the study period,” says Carroll. “However, there were no significant improvements in elevated triglyceride levels seen in Mexican-American men. For non-Hispanic white adults, declining trends were observed in both men and women, but no change was observed in the percentage of non-Hispanic black men or women with elevated triglycerides.”

During the entire study period, the percentage of adults with elevated triglyceride levels was consistently lower in non-Hispanic black adults than in non-Hispanic white or Mexican-American adults. “This finding supports what has been documented in previous studies,” Carroll adds. Research has suggested that a possible explanation for this phenomenon is that levels of lipoprotein lipase are higher among blacks than whites.

 

Continuing Efforts

Research has shown that several factors affect triglyceride levels, including a sedentary lifestyle, increased body weight, and cigarette smoking. Other efforts that may lower triglyceride levels include reducing intake of simple carbohydrates, trans-fatty acids, and alcohol. Monounsaturated and polyunsaturated fatty acids and marine-based omega-3 products may reduce triglyceride levels, according to published research.

The study by Carroll and colleagues did not speculate about the causes of the shift in triglyceride levels, but it is possible that several factors may be at play. These include a smaller percent of adults who smoke cigarettes, the decline in plasma concentrations of trans-fatty acids, and the increased percent of adults taking cholesterol-lowering medications.

Some clinical trials have shown that triglyceride levels can drop between 10% and 30% when patients with elevated triglycerides use statin monotherapy. However, more studies are necessary to definitively demonstrate the benefits of statins on reducing triglyceride levels.

Readings & Resources (click to view)

Carroll MD, Kit BK, Lacher DA. Trends in elevated triglyceride in adults: United States, 2001–2012. NCHS Data Brief. 2015:198. Hyattsville, MD. National Center for Health Statistics. Available at: www.cdc.gov/nchs/data/databriefs/db198.htm.

Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123:2292-2333.

Summer AE, Finley KB, Genovese DJ, Criqui MH, Boston RC. Fasting triglyceride and the triglyceride-HDL cholesterol ratio are not markers of insulin resistance in African Americans. Arch Intern Med. 2005;165:1395-1400.

Vesper HW, Kuiper HC, Mirel LB, Johnson CL, Pirkle JL. Levels of plasma trans-fatty acids in non-Hispanic white adults in the United States in 2000 and 2009. JAMA. 2012;307:562-563.

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