Clients TG down significantly but LDL remains the same

Medical Q&A [Moderated]
1

Not trying to play doctor and my client is working with his physician and taking his guidance.

First readings are from 2 months ago and the latest are this week. I can see that it’s really high and we had been trying to reduce the numbers with lifestyle factors but hasn’t worked.

I’m going to take a stab that there’s a genetic component since he’s generally pretty healthy, doesn’t drink, smoke, eat much saturated fats and is a decent body weight, although has a little centralised adiposity (not sure of his metabolic function).

Is there any reason that triglycerides might be so significantly down (assuming tested in the same conditions) and is this even beneficial? From reading the Sigma statements it seems it might just be a proxy measure?

Non HDL 308 316
Total Cholesterol 347 360
Triglyceride 235 71
HDL 39 44
LDL 285 285
VLDL 47 14.2
2

This looks like the difference between a fasted (lower TG) and non-fasted (high TG) panel. The non-HDL and LDL-C levels do raise suspicion for familial hypercholesterolemia.

3

What changes / interventions were implemented between these two panels?

Is there any known family history?

4

He just told me that first test was after lunch, second was 5 hours fasted. Probably explains it all.

Increased fibre, reduced saturated fat and some plant stanols, also a small amount of weight loss. Father had a stent at 45, which I just found out.

5

With a persistent non-HDL-c > 300 mg/dL and that family history, this a high-risk situation where lifestyle interventions alone are unlikely to be sufficient.