Know Your Numbers #1: Triglycerides
Before my heart attack, my lab reports were full of numbers that were “a little high” or “borderline.” None of them were bad enough for anyone to worry about, including me.
In fact, I didn’t even know my numbers back then. All I knew was that they were “kinda OK.”
HUGE MISTAKE!
I call this the Borderline Trap. Doctors have a formal name for it: metabolic syndrome. You have it if three or more of these five numbers are off:
Triglycerides: 150 mg/dL or higher
HDL (“good”) cholesterol: under 40 for men, under 50 for women
Blood pressure: 130/85 or higher
Fasting blood sugar: 100 mg/dL or higher
Waist size: over 40 inches for men, 35 for women
(Being on medication for any of these counts too.)
Notice what’s missing: LDL and total cholesterol. Metabolic syndrome isn’t about how much cholesterol you have. It’s about how well your body handles fuel. You can have great LDL and still be caught in the Borderline Trap.
This series walks through these numbers one at a time. We start with the one most people skip right past: triglycerides.
What are triglycerides?
Triglycerides are the main form of fat in your body and in your food. The name describes the structure: three (“tri”) fatty acids attached to a glycerol backbone.
They’re NOT the enemy. They’re fuel. Your muscles burn them for energy, and your body stores the extra in fat cells for later.
The problem isn’t having triglycerides. It’s having too many of them floating around in your blood for too long.
Where do they come from?
Two places:
Your food. When you eat fat, your gut packages it into particles and sends it into your bloodstream.
Your liver. This is the part that surprised me. When you eat more sugar, refined carbs or alcohol than your body can use, your liver turns the extra into triglycerides and ships them out.
So a high triglyceride number often isn’t about eating too much fat. Many times it’s your liver telling you it’s getting more sugar and starch than it can handle.
And the foods that are easiest to overeat, the ones you can’t stop at one of, usually aren’t pure fat or pure sugar. They’re both together. More on that another time.
Why they need to be cleared
Think of triglycerides as packages riding in delivery trucks through your bloodstream. Along the walls of your blood vessels are unloading docks. Your muscles and fat cells pick up the packages, and the empty trucks head back to the liver.
When things work well, the trucks unload quickly and your blood clears within a few hours of a meal.
When they don’t, two things go wrong:
The trucks pile up. Your liver keeps sending more, and the docks can’t keep up. This is common when your body has trouble handling sugar, which is the heart of the Borderline Trap.
The leftovers do damage. The half-empty trucks still carry cholesterol, and they’re small enough to slip into your artery walls. That’s where plaque begins.
At very high levels, 500 mg/dL and up, triglycerides can also inflame your pancreas, which is a medical emergency.
What’s a good number?
Here’s how labs usually grade a fasting triglyceride result (in mg/dL):
Under 150: “normal”
150 to 199: borderline high
200 to 499: high
500 and up: very high
Here’s the edgy part. “Normal” isn’t the same as optimal. The American Heart Association has said that an optimal fasting level is under 100. Plenty of people sitting at 140 are told they’re fine, and on paper, they are.
That’s the Borderline Trap in action: 149 gets a pass. 151 counts toward metabolic syndrome. Your arteries don’t know the difference.
The 2026 cholesterol guidelines now list triglycerides that stay at 150 or above as a “risk enhancer,” which means your doctor should factor them into how aggressively to treat your overall risk.
My numbers
On the night of my heart attack, my triglycerides were 111.
The lab called that normal, and nobody mentioned it. But it was above the optimal mark of 100, and it wasn’t the only borderline number on my report. One at a time, none of them looked like a problem.
My latest check: 47. Same body. Different plate.
What to ask at your next appointment
What were my triglycerides on my last panel, and was I fasting?
Are they under 100? If not, what do you think is driving them?
Are they trending up or down over the past few years?
One more thing. Triglycerides tell you even more when you put them next to another number on the same lab report. I’ll show you which one later in this series. It’s one of the questions I wish someone had told me to ask.
As always on Thursdays, the small things that matter:
This week's happiness check
Enjoyment: A podcast where Dr. Andrew Huberman explained how breathing changes your heart rate. When you breathe in, it speeds up a little. When you breathe out, it slows down. I’ve watched that pattern on my own monitors for months, and now I finally understand why.
Satisfaction: Getting my cardiologist to agree to a slow, stepped plan for restarting my meds. I asked, I explained why, and he said yes.
Meaning: Hoping one reader pulls up an old lab report this week and finds a number nobody mentioned.
What’s yours? Hit reply. I read every one.
Dennis
Cardiac Survivor · Your Friend in Recovery
Spokane, Washington
I’m a heart attack survivor, not a doctor. This is my personal experience and is for educational purposes only. Talk with your own care team before changing anything about your treatment.
P.S. If you have an appointment coming up, I put together a printable list of the questions I wish I’d asked my cardiologist. Grab it here.
P.P.S. New here? The glossary has plain-English definitions of Holter monitor, NSVT, ejection fraction and every other term I use: newsletter.cardiacsurvivor.org/p/glossary