How triglycerides silently raise heart risk in young Indians

At 35, Priya (name changed), an IT professional from Bengaluru, thought she was reasonably healthy. She had gained some weight after years of working from home, exercise had slipped down her list of priorities, and late-night food deliveries had become routine. She was not diabetic, her blood pressure was normal, and her LDL cholesterol — the number everyone talks about — was mildly elevated at 120 mg/dL (optimal being 100 mg/dL).

Then came her annual health check. Her triglycerides had shot up to 350 mg/dL, well above the ideal limit of 150 mg/dL. While her LDL cholesterol was not alarming, the combination with high triglycerides significantly increased her heart attack risk. Many people focus on cholesterol and ignore triglycerides, but in many Indians, high triglycerides are the earliest sign that metabolism is going wrong.

Triglycerides are the most common type of fat in the body. They act as the body's energy reserve. After eating, the body uses calories it needs immediately for energy. Any excess calories — particularly from sugar, refined carbohydrates and alcohol — are converted by the liver into triglycerides. These are carried through the bloodstream and stored in fat cells to be used later. Without triglycerides, the body would have no efficient way to store excess energy.

Problems arise when the body constantly receives more calories than it burns. With a sedentary lifestyle and diets high in sugary drinks, sweets, desserts, refined flour and polished rice, the liver keeps converting excess glucose into triglycerides. Over time, these fats accumulate in the bloodstream because the body produces them faster than it can use or store them safely. High triglycerides indicate that the body's metabolism is under strain.

This explains why someone whose diet contains relatively little fat can still develop very high triglyceride levels. Excess sugar and excess calories often drive the problem, not necessarily the oil on your plate.

Persistently elevated triglycerides are linked to insulin resistance, fatty liver disease, obesity and Type 2 diabetes. They also contribute to cardiovascular disease by increasing the number of cholesterol-rich particles in the blood and promoting the formation of smaller, denser LDL particles, which are more likely to penetrate artery walls and form plaques. Very high levels — typically above 500 mg/dL — increase the risk of acute pancreatitis, a life-threatening inflammation of the pancreas.

Indians are particularly vulnerable. Triglyceride levels between 200 and 300 mg/dL are becoming increasingly common among Indians, even in relatively young adults. Genes play a role, but only a small percentage of patients have primarily genetic causes. For most, poor lifestyle, weight gain, physical inactivity, excessive sugar intake, refined carbohydrates and insulin resistance are to blame.

Indians also tend to develop metabolic abnormalities at lower body weights than many Western populations. Fat accumulates around the abdomen, insulin resistance develops earlier, and the liver begins producing more triglycerides long before diabetes is diagnosed. Thus, a person may appear only slightly overweight yet already have significantly increased cardiovascular risk.

The encouraging news: triglycerides are among the most responsive blood markers to lifestyle changes. Unlike many inherited cholesterol disorders, elevated triglycerides often drop dramatically when the underlying metabolic imbalance is corrected. Reducing sugar intake is usually the first step. Sweetened beverages, desserts, bakery products and refined carbohydrates need to be cut. Regular exercise, weight loss, and a diet rich in whole foods can bring triglycerides down to healthy levels.