This condition is associated with the appearance of many chronic diseases such as obesity, hypertension, diabetes mellitus, etc.
Dyslipidemia or hyperlipidemia increases the plasma concentration in unhealthy levels of cholesterol and lipids in the blood.
Just as other conditions cause a decrease in the quality of life and even the death of patients who suffer from it.
The blood contains mainly three types of lipids:
- High-density lipoprotein (LAD).
- Low-density lipoprotein (LBD).
The appearance of dyslipidemia is associated with high levels of LDL and triglycerides or levels of LAD too low.
LBD lipids are considered the “bad” type of cholesterol because they can accumulate and form lumps or plaques on the walls of your arteries.
In contrast, the LAD is called “good” cholesterol because it contributes to eliminating LDL in the blood.
Triglycerides come from the calories that are ingested but not burned immediately.
These triglycerides are stored by the body in fat cells and released as energy when needed.
Therefore, if the intake of carbohydrates is higher than what your body needs, there is an increased accumulation of triglycerides.
Hyperlipoproteinemia is a condition that occurs when the body has trouble breaking down LDL cholesterol or triglycerides.
Types of dyslipidemia
Dyslipidemias are traditionally classified by elevation patterns observed in lipids and lipoproteins.
This system divides dyslipidemia into primary and secondary types. Hereditary factors cause primary dyslipidemia.
Among the specific types of primary dyslipidemia are:
- Mixed family hyperlipidemia:
This is the most common type of dyslipidemia of LDL cholesterol and high triglycerides due to genetic factors (polygenic disease) and environmental factors (inadequate diet and absence of physical exercise).
With this combined family hyperlipidemia, these problems can develop from adolescence.
There is an increased risk of early coronary artery disease, leading to a heart attack.
- Familial hypercholesterolemia and polygenic hypercholesterolemia:
They are characterized by high total cholesterol. In other words, the sum of the LBD and LAD levels and half the triglycerides level.
The ideal total cholesterol level is below 200 milligrams per deciliter (mg / dL).
- Hyperapobetalipoproteinemia family:
This condition reveals high levels of apolipoprotein B, a protein that is part of LDL cholesterol.
Secondary dyslipidemia is an acquired condition. That means that it develops from other causes.
Dyslipidemia usually does not present symptoms; its detection is made with the appearance of asymptomatic vascular disease.
We can highlight stroke, coronary artery disease (CAD), and peripheral arterial disease.
These cardiovascular diseases can be symptomatic.
High levels of LDL cholesterol are associated with coronary artery disease, which is a blockage in the heart’s arteries, and peripheral arterial disease, which is a blockage in the streets of the legs.
The main symptom of peripheral arterial disease is a pain in the legs when walking; these diseases can also cause chest pain and heart attack.
Patients presenting the homozygous form of familial hypercholesterolemia may present findings of flat or tuberous xanthomas.
Flat xanthomas are flat or slightly raised patches of yellowish color, and tuberous xanthomas are painless and firm nodules usually located on the extensor surfaces of the joints.
Patients who present severe elevations of triglycerides may have eruptive xanthomas on the trunk, back, buttocks, knees, elbows, hands, and feet.
Patients with rare dysbetalipoproteinemia may have palmar and tuberous xanthomas.
Causes and risk factors
The causes of dyslipidemia are primary (genetic) and secondary (lifestyle and others). These contribute to dyslipidemias in varying degrees.
The primary causes are single or multiple gene mutations resulting in overproduction or defective triglycerides and LDL cholesterol elimination.
As well as insufficient production or excessive clearance of LAD.
The vocabulary of many primary disorders was made by an old classification based on how lipoproteins were detected and distinguished.
In addition to the way they separated into alpha (LAD) and beta (LBD) bands on electrophoretic gels.
Secondary causes contribute to the appearance of dyslipidemia in adults.
These causes are:
- Diets are rich in saturated fats and trans fats.
- Sedentary lifestyle
- Excessive alcohol consumption.
- Advanced age.
- Certain drugs such as thiazides, beta-blockers, retinoids, highly active antiretroviral agents, cyclosporine, tacrolimus, estrogens and progestins, and glucocorticoids.
These drugs represent essential risk factors that develop the disease and later give way to conditions such as diabetes, chronic kidney diseases, hypothyroidism, and obesity.
Secondary causes of low HDL cholesterol levels include smoking, anabolic steroids, HIV infection, and nephrotic syndrome.
Dyslipidemia is commonly diagnosed by measuring serum lipids.
Routine lipid profile measurements include LDL cholesterol and, LDL cholesterol, total cholesterol (TC).
This will reveal if the levels are high, low, or in a healthy range.
Patients who suffer from premature atherosclerotic cardiovascular disease, cardiovascular disease with normal or near-normal lipid levels, or elevated LDL levels should be included for diagnosis a measurement of Lipoprotein levels.
HDL levels can not always predict cardiovascular risk.
So when it comes to genetic disorders, high levels of LAD may not protect against cardiovascular diseases. In the same way, low levels of LAD may not increase the risk of cardiovascular disorders.
Although LAD levels can predict cardiovascular risk in patients, the increased risk may correspond to the presence of other factors.
Like the metabolic anomalies and the lipid accompaniment, instead of the own level of LAD.
Treatment of dyslipidemia
The main aim pursued in treating dyslipidemia is to prevent atherosclerotic cardiovascular diseases.
Including acute coronary syndromes, cerebrovascular accidents, transient ischemic attack, or peripheral arterial disease presumed to be caused by atherosclerosis.
Treatment options will depend on the specific abnormality that occurs in lipids.
In some patients, the presence of a single anomaly may require several therapies; in others, however, a single medication may be adequate for several abnormalities.
Statins are the commonly used treatment for LDL cholesterol reduction because they reduce cardiovascular morbidity and mortality.
The treatment with statins is classified as high, moderate, or low intensity.
It is administered according to the morbidity of the patient other medications, risk factors of adverse events, age, intolerance to statins, cost, and patient preference.
The mechanism of action of statins inhibits hydroxymethylglutaryl-CoA reductase, an enzyme involved in the synthesis of cholesterol. It leads to the regulation of LDL receptors and the increase in LBD clearance.
Statins may also decrease intraarterial and systemic inflammation, stimulating endothelial nitric oxide production, and may have other beneficial effects.
Adverse effects are rare; these include myositis or rhabdomyolysis and elevated liver enzymes.
The latter is rare, and severe hepatic toxicity is extremely rare.
Muscle problems can be dose-dependent in many cases.
Adverse effects commonly occur in elderly patients, with various disorders and with the prescription of several medications.
In these cases, the change from one station to another or the dose reduction solves the problem.
Prevention begins by performing periodic examinations and taking the appropriate tests about the values of total cholesterol, LDL cholesterol, LDL cholesterol, triglycerides, and the relationship between LDL cholesterol and LDL cholesterol.
Perform periodic examinations with the doctor and their relevant controls. If the disease exists in conjunction with the treatment, it should be recommended:
- The adoption of a lifestyle where a routine of daily exercise is carried out with the consequent loss of weight.
- A change in diet should exclude the consumption of saturated fats and refined sugar. I am adding more fruits, vegetables, lean proteins, and whole grains.
- All types of animal fats should be replaced by olive oil, avocados, or almonds as an alternative source of fats.
- Reduce the consumption of alcohol or dispense with it.
- Give up smoking.
As a preventive measure for patients with a family history of high blood cholesterol levels, recommendations should be aimed at leading a healthy life long before their cholesterol numbers move to unhealthy levels.
Since it is with the adoption of preventive behaviors, the risk factors of contracting dyslipidemia can be reversed favorably for health.