Ask Dr. H: High triglycerides do have a role in heart disease

Question: My triglyceride level was 419 and my doctor recommended that I take the drug Tricor to lower it. Since I feel fine, do I need to take it? Why is an elevated triglyceride level bad? What raises the triglycerides?

Answer: Triglycerides are a part of the total cholesterol in your blood. For years, we weren't quite sure whether or not treating triglycerides made a difference in preventing heart disease. High levels over 400 usually got treated, while numbers between 200 and 400 were treated at the doctor's discretion. It turns out that high triglycerides do need to be addressed, and they do play a role in the development of heart disease. The current cholesterol guidelines consider a level above 150 to be too high.

When the triglycerides are elevated, it tends to shift the population of LDL "bad" cholesterol to a small, denser, and more damaging variety. For example, an LDL of 130 with a triglyceride level of below 150 is less damaging than an LDL of 130 with a triglyceride level like yours of 419. The LDL number is the same, but "pound for pound" the LDL is nastier when the triglycerides are elevated. What's more, we also notice a drop in the level of HDL "good" cholesterol when the triglycerides are elevated. So lowering the triglycerides might modestly improve the HDL level.

What elevates triglycerides?

The four major factors are fats, alcohol, sugar, and a genetic predisposition to have elevated triglycerides. Here's some food for thought:

A study published in the April 2, 2002, issue of the Annals of Internal Medicine showed that a single high-fat meal given to healthy men (average age, 29 years) without heart disease not only transiently raised their triglyceride levels from 100 to 250 after 5 hours, but also caused coronary artery blood flow reserve to the heart to decrease by about 18 percent. The implication is that a high-fat meal that raises triglycerides may cause chest pain or cause a heart attack.

With bacteria in urine, why no more infections? They're good bacteria

Question: I recently read that urine is not actually sterile and free of bacteria. How can that be so? If we all have bacteria in the urine, how come we all don't have urinary tract infections?

Answer: It's always been the teaching that urine is normally sterile and free of bacteria. However, a study from researchers at Stritch School of Medicine-Loyola University just published in the April 2012 issue of the Journal of Clinical Microbiology has shown that bacteria are indeed present in the urinary bladders of healthy folks, as well as in folks who have symptoms of a urinary tract infection but a "negative" culture.

Their research suggests that just like in the intestines, there may be "healthy" bacteria present in the urinary bladder that help keep "bad" bacteria populations under control and block infection. The most common bacteria identified by advance DNA-based testing were Aerococcus and Actinobaculum, two bacteria that are rarely found with traditional methods of detection.

Additionally, they've also shown through advanced DNA-based testing that folks who feel as if they have a bladder infection may indeed have a verifiable infection that cannot be identified by a traditional urine culture. For years, we've accepted the urine culture as the "gold standard" for identifying whether or not an infection is present. DNA-based detection methods may replace or supplement the urine culture method.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," Box 767787, Atlanta, Ga. 30076. Due to the large volume of mail received, personal replies are not possible.