Hyperlipidemia

February 2, 2017

Hyperlipidemia is a medical condition characterized by elevated levels of lipids and cholesterol in the blood, and is also identified as dyslipidemia, to describe the manifestations of different disorders of lipoprotein metabolism. Genetic predisposition, cigarette smoking, obesity, poor diet, and a sedentary lifestyle can all lead to hyperlipidemia.

Although hyperlipidemia does not cause symptoms, it can significantly increase your risk of developing cardiovascular disease, including disease of blood vessels supplying the heart (coronary artery disease), brain (cerebrovascular disease), and limbs (peripheral vascular disease). These conditions can in turn lead to chest pain, heart attacks, strokes, and other problems. Because of these risks, treatment is often recommended for people with hyperlipidemia.

It is commonly referred to as high cholesterol. One-third of American adults have it, only 1 in 3 have it under control, and having hyperlipidemia doubles the risk of developing heart disease.

What is Lipid? Lipid is the scientific term for fats in the blood. Cholesterol is essential for the formation of cell membranes and the manufacture of several hormones. At proper levels, lipids perform important functions in the body, but can cause health problems if they are present in excess. High lipid levels can speed up a process called atherosclerosis, or hardening of the arteries. The arteries are normally smooth and unobstructed on the inside, but as the age increases, a sticky substance called plaque forms in the walls of the arteries. Plaque is made of lipids and other materials circulating in your blood. As more plaque builds up, the arteries can narrow and stiffen. Eventually, enough plaque may build up to reduce blood flow through the arteries. Atherosclerosis increases the risk of heart disease, stroke, and other vascular diseases.

Even the brain depends on cholesterol for proper functioning. Cholesterol becomes a problem when too much of the bad kind is produced or ingested through regular eating of unhealthy foods. Cholesterol is carried through the blood to cells by lipoproteins that are either low density (LDL) or high density (HDL). Think of the lipoprotein as the vehicle and cholesterol as the passenger.

HDL is the good lipoprotein because it carries extra cholesterol back to the liver where it can be eliminated. LDL is bad, as it will build up excess cholesterol in the blood.

Types of Hyperlipidemia

This condition is divided into two subtypes which are: primary hyperlipidemia and secondary hyperlipidemia.

  • Primary Hyperlipidemia – This usually takes place as a result of genetic problems i.e., mutation within receptor protein.

 

  • Secondary Hyperlipidemia – This will arise as a result of other underlining diseases like diabetes. Alteration and/ or abnormality in the metabolism of lipid and lipoproteins is a very common condition that taken place within general population, and it consider as one of the main risk factor in the incidence of cardiovascular disease due to their influence on atherosclerosis.

Causes

The causes of hyperlipidemia are either genetic (familial or primary hyperlipidemia) or from a poor diet and other specific factors (secondary hyperlipidemia). When the body cannot utilize or remove the excess fat, it accumulates in the blood. Over time, the buildup damages the arteries and internal organs. This process contributes to the development of heart disease.

In familial hyperlipidemia, the high cholesterol has nothing to do with poor habits but is caused by a genetic disorder. There is a greater chance of developing hyperlipidemia if a man is older than age 45 or a woman is older than age 55. The causes also include –

  • Hereditary factors are the most common cause.
  • A diet high in saturated fat and cholesterol increases blood cholesterol and triglyceride levels.
  • Other disorders, such as diabetes mellitus, kidney disease, and hypothyroidism, may promote hypertriglyceridemia.
  • Certain drugs, such as estrogen, corticosteroids, retinoids, protease inhibitors, thiazide diuretics, and beta-blockers, may cause hypertriglyceridemia.
  • Obesity increases the risk of hyperlipidemia.
  • Chronic, excessive alcohol use increases the risk of hypertriglyceridemia.
  • Smoking and not exercising may lead to hyperlipidemia.
  • Steroid uses, alcoholism, hypothyroidism, oral contraceptives, chronic renal failure, hypopituitarism and nephritic syndrome are other contributors to hyperlipidemia.

 

Symptoms

In the early years there may be no symptoms. When symptoms appear, they may include –

  • Chest pain (angina) or other signs of coronary artery disease; may be present at a young age.
  • Cramping of one or both calves when walking.
  • Sores on the toes that do not heal.
  • Sudden stroke-like symptoms, such as trouble speaking, drooping on one side of the face, weakness of an arm or leg, and loss of balance.

People with this condition may develop high cholesterol or high triglyceride levels as teenagers, or the condition may be diagnosed when people are in their 20s and 30s. The levels remain high all during life. Those with familial combined hyperlipidemia have an increased risk of early coronary artery disease and heart attacks. They also have higher rates of obesity and are more likely to have glucose intolerance.

Excessive fat in the blood accumulates over time, forming plaques on the walls of the arteries and blood vessels. This will narrow the openings, producing turbulent blood flow through the vessels, and cause the heart to use more force to get the blood through the constricted areas.

 

 

Treatment

Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if these important lifestyle changes are made and still the cholesterol levels remains high, the doctor may recommend medication.

The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, the current health and possible side effects. Common choices include –

  • Statins — Among the most commonly prescribed medications for lowering cholesterol — block a substance the liver needs to make cholesterol. This causes the liver to remove cholesterol from the blood. Statins may also help the body reabsorb cholesterol from built-up deposits on the artery walls, potentially reversing coronary artery disease. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
  • Bile-acid-binding resins – The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts the liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in the blood.
  • Cholesterol absorption inhibitors – The small intestine absorbs the cholesterol from the diet and releases it into the bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.
  • Combination cholesterol absorption inhibitor and statin – The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in the small intestine and production of cholesterol in the liver. It’s unknown whether Vytorin is more effective in reducing heart disease risk than taking simvastatin by itself.
  • Injectable medication – A new class of drugs can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in your blood. The Food and Drug Administration recently approved alirocumab (Praluent) and evolocumab (Repatha) for people who have a genetic condition that causes very high levels of LDL. These drugs also may be used for people who have had heart attacks or strokes and need additional lowering of their LDL levels. These injectable drugs are administered at home one or two times a month.

 

Alternative Treatment

Nutritional Supplements

  • Marine-derived omega-3 polyunsaturated fatty acids (fish oil) are often touted as being preventative of major cardiovascular adverse outcomes by the postulated mechanisms of lowering triglyceride levels.
  • Garlic is used most frequently as a dietary supplement for treatment of hyperlipidemia, heart disease, and hypertension. A well-conducted, randomized trial demonstrated that there was no significant difference in LDL-cholesterol, HDL-cholesterol, triglycerides, or total cholesterol-HDL. There is evidence that garlic is associated with blood pressure reductions in patients with elevated systolic blood pressures.
  • Ginseng has a plethora of cardiovascular benefits, including cardioprotection, antihypertensive effects, and attenuation of myocardial hypertrophy and heart failure.
  • Ginkgo biloba is purported to have cardioprotective effects by several studies through its antioxidant, antiplatelet, antithrombotic, vasodilatory, and antihypertensive properties.
  • Hawthorn leaf and flower extracts are advocated as an oral treatment option for patients with chronic heart failure; in fact, the German Commission E approved the use of hawthorn extracts in patients with heart failure graded stage 2.
  • Flaxseed supplementation was associated with a decrease in blood total and LDL-cholesterol concentrations but did not significantly affect HDL-cholesterol and triglycerides. Flaxseed contains a large amount of fiber, and dietary soluble fiber has been shown to have cholesterol-lowering effects.
  • Antioxidants, which include anthocyanins, beta-carotene, catechins, coenzyme Q10, flavonoids, lipoic acid, lutein, lycopene, selenium, and vitamins C and E, have shown promising results in laboratory and observational studies; however, systematic reviews of the literature and large, randomized, controlled trials have generally found no beneficial effects of antioxidant supplements for primary or secondary prevention. In fact, vitamin A, beta-carotene, and vitamin E may actually increase mortality.
  • Red yeast rice contains monacolin K, which has the same chemical structure as lovastatin, an inhibitor of HMG-CoA reductase. Monacolin K in substantial amounts lowers blood levels of total cholesterol and LDL-cholesterol.
  • Soy protein and isoflavones (phytoestrogens) have gained attention for their potential role in improving risk factors for CVD (Cardio Vascular Diseases).
  • L-carnitine is FDA approved for replacement therapy in primary (i.e., inborn errors of metabolism) and secondary (i.e., secondary to hemodialysis) L-carnitine deficiencies. Many clinical trials have suggested acetyl-L-carnitine (ALC) and propionyl-L-carnitine (PLC), two naturally occurring carnitine derivates, as potential strategies in the management of peripheral arterial disease (PAD), heart and cerebral ischemia, and congestive heart failure.
  • Chelation therapy is used to rid the body of excess or toxic metals (i.e., in lead poisoning). Studies suggest that EDTA chelation as a treatment for coronary heart disease (CHD).

Complementary Treatment

Relaxation techniques include practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep-breathing exercises. The goal of these techniques is to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure and oxygen consumption, and a feeling of calm and well-being.

Meditation refers to a group of techniques such as mantra meditation, mindfulness meditation, transcendental meditation, and Zen Buddhist meditation. There is evidence that meditation is associated with potentially beneficial health effects.

Yoga has many different styles, some more physically demanding than others. In general, practicing yoga, as well as other forms of regular exercise, leads to several cardiovascular benefits. Yoga typically causes increased heart rate during the act, but following prolonged training, a decrease occurs in exercise-induced heart rate.

Acupuncture is a therapeutic modality anchored in traditional Chinese medicine (which also includes Chinese herbal medicine, moxibustion, cupping, Chinese massage, mind-body therapies such as Qigong and tai chi, and dietary therapy)

 

Reference –

http://www.medicinenet.com/script/main/art.asp?articlekey=3838

http://www.drugs.com/health-guide/high-cholesterol-hypercholesterolemia.html

http://www.uptodate.com/contents/high-cholesterol-and-lipids-hyperlipidemia-beyond-the-basics#H3

http://www.researchgate.net/publication/262817622_A_REVIEW_OF_HYPERLIPIDEMIA_AND_MEDICINAL_PLANTS

https://shcs.ucdavis.edu/topics/hyperlipidemia.html

http://www.aafp.org/afp/2007/1001/p1027.html

http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/basics/alternative-medicine/con-20020865

http://ocvalidate.imngmedicalmedia.com/onecount/redirects/index.php?action=get-tokens&return=http%3A%2F%2Fwww.jfponline.com%2Findex.php%3Fid%3D22143%26tx_ttnews%5Btt_news%5D%3D166696

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