The Triglyceride 100 Rule: A Simple Number That Says a Lot About Your Health
For years, triglycerides were the overlooked member of the cholesterol family.
Most of the attention went to LDL (“bad” cholesterol) and HDL (“good” cholesterol), while triglycerides sat quietly on the lab report—often ignored unless they climbed above 200 mg/dL.
But that’s changing.
Recent cholesterol guidelines have finally given triglycerides the attention they deserve. And what we’re learning is striking: this once-overlooked number may be one of the clearest windows into your overall metabolic health.
Why 100 Matters
Research now shows that an optimal triglyceride level is below 100 mg/dL—a concept known as the Triglyceride 100 Rule.
In our Baltimore Coronary Observational Long-Term Study (COLTS), we found that individuals with triglycerides under 100 had about a 50% lower risk of future cardiovascular events.
But the story doesn’t stop with heart disease.
Triglycerides below 100 are also linked to:
- Lower risk of type 2 diabetes
- Reduced likelihood of fatty liver disease
- Better overall metabolic function
In other words, this single number reflects how efficiently your body is handling fats and carbohydrates, how sensitive you are to insulin, and how hard your liver is working.
Think of it as a snapshot of your cardiometabolic “tone.”
What Happens When Triglycerides Rise?
As triglycerides creep above 100, several harmful processes begin to take shape:
- Insulin resistance develops
Higher triglycerides and insulin resistance fuel each other, increasing the risk of diabetes. - Arteries are exposed to more harmful particles
Elevated triglycerides signal an increase in atherogenic lipoproteins (like VLDL remnants), which contribute to plaque buildup. - The liver becomes overloaded
Excess triglycerides accumulate in the liver, driving metabolic-associated steatotic liver disease (MASLD), formerly known as fatty liver. - At very high levels, serious complications can occur
When triglycerides exceed 500 mg/dL, the risk of acute pancreatitis—a potentially life-threatening condition—rises significantly.
A Simple, Powerful Goal
One of the most appealing aspects of the Triglyceride 100 Rule is its simplicity.
Unlike many health metrics that are difficult to interpret, this one is clear:
👉 Aim for a fasting triglyceride level below 100 mg/dL.
Even better, it’s highly responsive to lifestyle changes:
- Cut back on refined carbohydrates and added sugars
- Limit alcohol
- Engage in regular exercise (both aerobic and strength training)
- Maintain a healthy weight
The Big Picture
When your triglycerides are below 100, it’s not just about your cholesterol panel.
It’s a sign that:
- Your blood sugar is well controlled
- Your liver is functioning efficiently
- Your metabolism is working the way it should
- Your cardiovascular system is under less stress
In a field often filled with complex numbers and competing targets, the Triglyceride 100 Rule stands out.
It’s simple.
It’s meaningful.
And it tells a powerful story about your health.
Michael Miller, MD, MASPC, FACC, FAHA, FNLA is Cardiologist and Professor of Medicine, Hospital of the University of Pennsylvania. He is also Chief of Medicine, Corporal Michael J Crescenz VAMC (Philadelphia).
Prior to moving to Philadelphia in 2022, Dr. Miller served as Professor of Cardiovascular Medicine at the University of Maryland School of Medicine (Baltimore).
Check out Dr. Miller’s best selling book “Heal Your Heart” and learn more at www.drmichaelmiller.net
Michael Miller, MD
MASPC, FACC, FAHA, FNLA
Dr. Miller is a leading cardiologist and heart health expert whose pioneering research on positive emotions, diet, and physical activity supports the integration of all three modalities for optimal vascular health.