HYPERLIPIDEMIA
Hyperlipidemia is also known as a high lipid level in the blood of a human being. It is becoming one of the common problems in many people around the world and a high level of lipid can lead to many types of cardiovascular problems.
What is a lipid?
Lipids are molecules that have the property of being soluble in substances like ether, alcohol, and other organic solvents but lipids are not soluble in water.
Classification of lipids:-
1) SIMPLE LIPIDS: These are esters of fatty acid and alcohol.
Types of simple lipids:
A) Fats and oils – These are a combination of fatty acids with glycerol.
B) Waxes – These are a combination of fatty acid with aliphatic or alicyclic alcohol.
2) COMPLEX LIPIDS: These are a combination of fatty acid with glycerol and one more group. Examples of complex lipids include phospholipids, glycolipids, lipoproteins, and others.
Lipoprotein is a combination of lipids and protein. Lipoproteins are used in the transport of lipids like cholesterol or acylglycerols as lipids are not soluble in water and need lipoproteins for transport in plasma.
Lipoproteins are divided into
A) HDL (HIGH DENSITY LIPOPROTEIN ): HDL takes up the cholesterol that is not utilized by the tissue and transports it to the liver where it can be converted to bile and removed from the body or removed directly by the liver without any changes.
B) LDL (LOW-DENSITY LIPOPROTEIN ): It helps in the transport of cholesterol to various tissues of the body.
C) IDL ( intermediate density lipoprotein )
D) CHYLOMICRONS ( ULTRA LOW DENSITY LIPOPROTEIN ): Our food contains lipids which after reaching the intestine break down and form cholesterol and this cholesterol is taken up by the chylomicron and transported to the liver.
E) VLDL ( VERY LOW-DENSITY LIPOPROTEIN ): It is produced in the liver from the cholesterol and another lipid that reaches the liver. This VLDL is used by extrahepatic tissue.
3) DERIVED LIPIDS: This group of lipids includes fat-soluble vitamins, steroid hormones, and ketone bodies.
4) NEUTRAL LIPIDS: This group of lipid include cholesterol which does not possess any charge. example – cholesterol, and acylglycerols.
The general concept of people is that fat is bad for the body and that they should lose as much fat as possible and yes, excess fat in the body is bad for our health. But we need some fat in our body because they play some important functions for us.
Some of the important roles played by lipids for us are :
1) Lipid works as a cushion for some of our internal organs and protects them from external forces.
2) Lipid functions as a reserve source of energy.
3) Lipids are the source of fat-soluble vitamins like A, D, E, and K.
4) Lipids play a role in the formation of hormones like steroid hormones.
Lipids have a negative impact on the body only when the amount of concentration is more than the normal level. When the concentration of lipids is more in plasma then the chances of heart disease become more.
Risk factors for hyperlipidemia are :
1) Genetics: It has been found that children with parents who are suffering from hyperlipidemia are at increased risk of developing coronary artery disease due to high plasma lipid levels.
2) Age: with an increase in age the chances of hyperlipidemia increase however nowadays even middle-aged people are at increased risk of developing hyperlipidemia.
3) Obesity: overweight people are at increased risk of developing hyperlipidemia.
4) Sedentary lifestyle: people who lead a lifestyle with less physical activity are at increased risk of developing hyperlipidemia.
5) Saturated fatty acid food in the diet: A diet rich in saturated fatty acid food has a high risk of developing hyperlipidemia. Examples are food cooked in palm oil, butter, and cheese.
6) Diet rich in red meat.
7) Fewer vegetables and fruits in the diet.
8) High alcohol intake can have a negative impact on the liver and it can lead to hyperlipidemia.
9) Liver disease: people with liver disease have high chances of hyperlipidemia as the liver plays a major in the metabolism of lipid molecules.
10) Diabetes and hypothyroidism have a higher risk of developing hyperlipidemia if not controlled properly.
PATHOPHYSIOLOGY OF HYPERLIPIDEMIA:
Lipids tend to get deposited in the blood vessels and most commonly they get deposited in areas of bifurcation of the arteries.
The above-mentioned risk factor makes the endothelium of blood vessels permeable and this causes the lipids mostly LDL to pass from the tunica intima of blood vessels to its middle layer.
Through the permeable vascular endothelium, white blood cells pass and they also reach the middle layer of the blood vessels. It is called DIAPEDESIS. Diapedesis occurs because the vascular endothelium becomes sticky because of the risk factors and monocytes pass to tunica intima.
This monocyte functions as the macrophages phagocytose the LDL and become like a ball of fat and are called “Foam cells”.
When this macrophage dies then it forms a pool of cholesterol and slowly it starts pushing the tunica intima upward and platelets will start accumulating around it and forming atheroma plaques.
Macrophages release cytokine and platelets release platelet growth factor and these two cause mitosis of tunica media of blood vessels, due to mitosis the cells of tunica media grow over atheroma plaques and stabilize them.
This plaque causes obstruction in blood flow in the vessels and when they start getting bigger then obstruction becomes more and it can lead to cell death as the cell will be deprived of the oxygen carried by the blood.
This is how the cardiac problem arises if the plaque is formed in the cardiac blood circulatory vessels.
CLINICAL FEATURES :
Generally, a person with hyperlipidemia has no symptoms, and mostly it is an accidental finding during a routine health check-up or if a person present with diabetes or hypertension is going for a lipid checkup too.
Sometimes when cholesterol level is very high then some signs of high cholesterol can be seen :
1) Red or yellow papules mostly seen on buttocks of the person and it is known as Eruptive xanthomas.
2) Sometimes papules can be on the tendon of the body part like patella or Achilles tendon and this is known as Tendious xanthomas.
1) WEIGHT MANAGEMENT: An overweight person is at high risk for an increase in the blood lipid level and so it is important to keep the weight under control.
INVESTIGATION:
1) The blood investigation to be done is a TOTAL LIPID PROFILE test which includes LDL, HDL, VLDL, and TOTAL CHOLESTEROL.
2) LIVER FUNCTION TEST should be done too to check the status of the liver.
3) If a person is diabetic or is in the high-risk group then blood sugar levels should be checked too.
4) ECG should be done to check the cardiac condition.
5) If a person is suspected of cardiac problems or showing cardiac symptoms then echocardiography can be done too.
6) USG ABDOMEN can be done if liver function tests are abnormal, to look for any structural changes in the liver.
PREVENTION OF HYPERLIPIDEMIA
1) WEIGHT MANAGEMENT: An overweight person is at high risk for an increase in the blood lipid level and so it is important to keep the weight under control.
2) EXERCISE: Physical training is one of the best ways to keep weight and blood lipid levels under control.
3) DIET: It is very important to eat a healthy diet and include more vegetables and fruits in the diet.
A) Olive oil can be used for cooking which is a better alternative to other cooking oil. Some other oils which can also be used for cooking are sunflower or corn oil.
B) Reduce the amount of butter, cheese, and fried food intake.
C) Reduce the amount of meat consumption.
D) Garlic has been found to have a beneficial effect on cardiovascular health. So garlic can be included in food while cooking.
E) Soya protein can be included in the diet as it has a beneficial effect on the control of cholesterol levels.
F) Vitamin C-rich foods like oranges, lemons, tomatoes, and grapes can be used too.
G) A fibrous diet like oats, and wheat is good for the control of cholesterol levels.
H) Sugar and salt intake should be controlled.
I) Control of alcohol consumption.
J) Stop smoking as it promotes plaque formation in blood vessels.
4) DISEASES: If suffering from diseases like diabetes, hypertension, or thyroid hormone imbalance then it is important to take proper medication and keep the disease under control to prevent any complications.
TREATMENT
If lipid level is not controlled with preventive measures or the patient is at risk of developing cardiac problems then it’s important to start medication.
After proper history taking and investigation the doctor can start the patient on any of the following medicines depending on the patient’s condition :
1) STATINS
2) BILE ACID-BINDING RESINS
3) NIACIN
4) FIBRIC ACID DERIVATIVE
THE HOME MESSAGE IS TO ALWAYS FOLLOW HEALTHY LIFESTYLE AND HEALTHY DIET TO STAY FIT AND IF SUFFERING FROM ANY DISEASE THEN TAKE ADVICE FROM A DOCTOR AND TAKE MEDICINE AS PRESCRIBED BY THE DOCTOR.
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Thanks Dr. For good info
Thanks and it is also useful for competitive students. Nice information
Thanks for the information ,well explained Dr.