What could be a potential underlying reason for normal non HDL (135) but high Triglycerides (290) assuming a lean individual? Would you have any further recommend reading or listening?
A non-HDL-c of 135 mg/dL is not “normal” (I don’t like the framing of “normal” vs. “abnormal” here anyway, as it is a continuous spectrum of risk). However, TG of 290 mg/dL are more elevated than we’d expect for someone with that non-HDL-c. This can happen in non-fasting samples depending on the preceding meal, or in other underlying disorders of lipid metabolism. If you have other data points, this tool can help illustrate the differential diagnosis for a given combination of parameters: https://apob.app
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That’s a very interesting tool, I don’t have the ApoB but just put in a normal one as I had LDL-C (just for learning purposes)
This was something interesting that I was not aware of.
“Low HDL is a major risk factor for vascular disease independent of the level of the proatherogenic lipoproteins”
Can HDL be influenced by diet?
In any case it seems, according to the site, that if ApoB is below 1.2g no clinical intervention is needed with respect to cardiovascular risk.
As a clinician, if you saw this (or higher TAGs) and it led to issues with the pancreas, how would you treat it, assuming the person was otherwise healthy and lean.
Edit: After reading more, I am thinking likely that this person needs to get an ApoB test due to lower HDL and higher TAGs, potentially leading to more VLDL → LDL particles
Yes, HDL-c can be influenced by diet, in a similar way to how it can impact LDL-c and TG as part of the atherogenic dyslipidemia pattern. To the extent dietary modifications improve insulin resistance and/or generate weight loss, for example, we often see increases in HDL-c levels.
As a clinician, if you saw this (or higher TAGs) and it led to issues with the pancreas, how would you treat it, assuming the person was otherwise healthy and lean.
If by “issues with the pancreas” you mean hypertriglyceridemia-induced pancreatitis, this gets treated aggressively in the hospital setting with intravenous insulin, as well as statin therapy, and occasionally the addition of fibrates. This is most often due to severe/uncontrolled insulin resistance/diabetes, but can occasionally be due to other lipid disorders including genetic causes of severe hypertriglyceridemia. However, pancreatic complications of high triglycerides do not tend to happen at levels of 290 mg/dL as quoted in the original post, but usually require much higher levels.
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