Hyperlipidemia also known as Hypercholesterolemia or Hyperlipoproteinemia is a broad term which refers to several acquired and genetic disorders giving rise to high level of plasma lipids (Fats, Cholesterol, and triglycerides), phospholipids, lipoproteins, including the high level of low density lipoprotein and very low density lipoprotein and decrease level of high density lipoprotein. It is the most common of dyslipidemia. Increased level of low-density lipoprotein is an important risk factor for atherosclerosis. It is one of the major risk factors for Atherosclerosis and cardiovascular disease. Cardiovascular disease accounts for 1/3rd of the deaths in the world.
Cholesterol is produced in the liver and is carried by the blood to different cells of the body with the help of lipoproteins. It is essential for the body as it helps in keeping cell membranes healthy, Storage of vitamins, hormone productions etc., but is bad for our heart when the low-density lipoproteins are decreased in the body. High-density lipoproteins (HD2) are called good lipoproteins because it carries the extra cholesterol not required by the body to the liver for its elimination. While low-density lipoprotein accumulates the extra cholesterol in the blood.
Types of Hyperlipidemia
It is of two types:- Primary & Secondary.
Primary (familial) hyperlipidemia results due to the genetic abnormalities. Secondary (acquired) hyperlipidemia occurs due to alterations in the lipid and lipoprotein metabolism resulting from underlying disorders. Acquired hyperlipidemia occurring due to the altered lipid and lipoprotein mimics the familial hyperlipidemia and may have similar consequences. Underlying disorders causing acquired hyperlipidemia are:-
- Diabetes Mellitus
- Excessive drinking of alcohol
- Kidney failure
- Drugs: Beta-blockers, thiazide diuretics, Estrogens
- Nephrotic syndrome
Symptoms of Hyperlipidemia
- Elevation of lipids levels only does not produce symptoms excepts pancreatitis. The symptoms are due to the formation of the atheromatous plaques on the arterial wall(atherosclerosis).
- Brain:- Stroke and Transient ischemic attack produce symptoms such as paralysis of the opposite half of the body, Slurring of speech, Deviation of mouth etc. These symptoms recover within one to twenty-four hours in the transient ischemic attack.
- Heart:- Angina and Heart attacks produce symptoms such as chest pain, Sweating, Anxiety, Syncope etc.
- Legs:- Leg cramps, leg pain, Intermittent claudication or even Gangrene, which may need Amputation.
- Pancreatitis:- Pain over the epigastric region radiating to back, Nausea, Vomiting, retching, Hiccough
Screening of the Hyperlipidemia should be done after 40 years of age. The screening includes measuring the lipid profile after overnight fasting. Lipid profile after overnight fasting. Lipid profile includes:-
- Total cholesterol
- 2 High-density lipoprotein cholesterol
- Low-density lipoprotein cholesterol
Total cholesterol<200mg/dl, Triglycerides<150mg/dl). High density lipoprotein <60mg/dl and low density lipoprotein <130mg/dl is an indicator of good cardiovascular health. High risk for cardiovascular events is found when total cholesterol level is more than 240mg/dl, Triglycerides is more than 200mg/dl, HDL cholesterol is less than 35 mg/dl and DL cholesterol is more than 160 mg/dl.
The old theory of lipid profile test should be done after overnight fasting is discarded now, and lipid profile can be done or investigated at any point in time after taking a meal.
Treatment of Hyperlipidemia
Treatment of primary(Familial) hyperlipidemia includes
- Taking lipid-lowering agent such as Atorvastatin.
- In some parts of the world, replacing the patient’s blood with the blood of the healthy individual is performed to reduce the serum cholesterol levels.
- Lifestyle modification and change of dietary habits.
Treatment of secondary (acquired) hyperlipidemia
- Lifestyle modification
Sedentary lifestyle should be replaced by physically active one. Regular daily exercise helps to lower the bad lipoprotein (LDL) and raise good lipoprotein(HDL).You should target 30 minutes of regular exercise for 5 days in a week. This also helps in shedding weight.
- Change in dietary habits
- Consumption of oatmeal, Avocado, fatty fish, salmon is good for cardiac health.
- Consumption of fatty food, Food rich in carbohydrates should be avoided.
- Plenty of vegetables and fruits should be included in diet chart.
- Avoid excessive consumption of alcohol.
Smoking ruins the cardiac health. In addition to forming plaque on the walls of arteries, it also increases the bad cholesterol (LDL). While the cessation of smoking increases good cholesterol (HDL).
Lipid-lowering agents such as statins (Atorvastatin, Rosuvastatin) should be taken to reduce the cardiovascular risk. In patients with hypertriglyceridemia are also prescribed with fibrates. Fibrates are highly effective in reducing triglyceride level but should be used only under observation as it causes Myopathy. Bile-acid sequestrants such as cholestyramine, Colestipol and colesevelam can also be used. Treat underlying causes of Hyperlipidemia such as Hypothyroidism, Diabetes.
Most patients have to follow these regimen throughout their life.