Dyslipidemia / Hypercholesterolemia

Dyslipidemia / Hypercholesterolemia

Dyslipidemia is the condition which is characterised by the abnormal rise of lipid levels within the bloodstream. This condition is a significant risk factor for various types of cardiovascular diseases since imbalances in the levels of lipids within the bloodstream can result in atherosclerosis (fat buildup within artery walls) and other cardiovascular complications. The dysregulation in the lipid levels could be either due to genetic predispositions, a bad lifestyle, or any other occult underlying health conditions.

Recognizing the importance of maintaining healthy lipid levels is crucial for the prevention of long-term health complications. Early diagnosis and intervention can effectively manage dyslipidemia, promoting overall cardiovascular health. Diagnosis often relies on lipid profile tests, with recommended target levels for optimal cardiovascular health.

Treatment strategies work to mitigate risks by targeting specific lipid abnormalities, emphasizing lifestyle modifications, and considering comorbidities to individualize care. Given the multifaceted nature of dyslipidemia management, a multidisciplinary approach is essential for comprehensive patient care.

Dyslipidemia Types

Dyslipidemia classification can be based on its causes and the constitution of lipid abnormalities. In the case of dyslipidemia classification based on its causes, it can be divided into two types. They are:

Primary Dyslipidemia: Variations in genetic mutations that affect the metabolism of lipids can cause this type of dyslipidemia. Primary dyslipidemia subtypes include familial hypercholesterolemia, familial hypertriglyceridemia, familial combined hyperlipidemia, familial dysbetalipoproteinemia, etc.

Secondary Dyslipidemia: This type of dyslipidemia is largely caused by bad lifestyle factors. It can also be caused by other medical conditions. It must be understandable that secondary dyslipidemia could be reversible or at least modifiable just by working on the underlying cause. Some examples of secondary dyslipidemia risk factors include unhealthy nutrition, physical inactivity, obesity, diabetes, hypothyroidism, chronic kidney disease, liver disease, alcohol abuse, smoking, etc.

In the case of dyslipidemia classification based on the constitution of lipid abnormalities, there are three types. They are:

  • Hypercholesterolemia
  • Hypertriglyceridemia
  • Mixed Dyslipidemia

Hypercholesterolemia: Elevated total cholesterol levels (low-density lipoprotein (LDL) cholesterol in particular). Low-density lipoprotein (LDL) cholesterol is called "bad cholesterol” since it could cause heart disease if the levels increase abnormally.

Hypertriglyceridemia: Increased levels of triglyceride can also contribute to cardiovascular risks and may be associated with metabolic disorders.

Mixed Dyslipidemia: Elevated levels of both cholesterol and triglycerides are seen in patients suffering from metabolic syndrome.

Symptoms of Dyslipidemia

Dyslipidemia typically does not present any noticeable symptoms. Nevertheless,  which is why it is often termed a "silent" condition. However, individuals may experience dyslipidemia signs and complications related to associated conditions, including:

  • Xanthomas: Yellowish skin discoloration that is usually seen on the skin of the eyelids (xanthelasma), palms, tendons, or other areas. Their manifestations would indicate high levels of cholesterol or triglycerides in the blood.
  • Arcus senilis: This is a gray or white ring around the eye’s cornea that is caused by cholesterol depositing in the corneal margin and indicates high cholesterol levels in the blood. This is more common in older people but can also occur in younger people with dyslipidemia.
  • Lipemia retinalis: This condition produces a milky appearance in the retinal vessels due to high blood triglyceride levels. This can blur the vision, indicating severe hypertriglyceridemia.
  • Lower limb ischemia: Commonly seen with peripheral artery disease, lower limb ischemia (lack of blood supply to lower limbs) is caused by the narrowing or blockage of the arteries that supply blood to the legs. It could be due to atherosclerosis.
  • Angina: Commonly seen with coronary artery disease, which blocks or narrows the arteries that supply blood to the heart due to atherosclerosis. The pain usually occurs when the heart needs more oxygen, such as during physical or emotional stress, and may radiate to the neck, jaw, shoulders, or back. Angina may indicate high levels of LDL cholesterol or triglycerides in the blood.
  • Strokes: Dyslipidemia increases the risk of atherosclerosis in cerebral arteries, contributing to sudden interruption of blood flow to the brain due to a clot or a bleed in weakened blood vessel walls. Symptoms may include sudden weakness, slurred speech, or visual disturbances

Causes of Dyslipidemia

Several factors contribute to the development of dyslipidemia, including:

  • Obesity: Abnormalities in lipid metabolism are common in obese patients. Around 60-70% of obese patients are dyslipidemic. Elevated levels of triglycerides, very low density lipoproteins, apolipoprotein B, and non-high-density lipoprotein (HDL)-C levels. Excess body weight is a significant risk factor for dyslipidemia.
  • Dietary Habits: High intake of saturated fats, trans fats, and cholesterol-rich foods can lead to elevated lipid levels.
  • Sedentary Lifestyle: Physical inactivity is linked to higher triglyceride levels and lower levels of high-density lipoprotein (HDL) cholesterol, which is known as "good" cholesterol.
  • Genetics: Altered levels of these lipoproteins may be related to genetic alterations in at least 40-60% of cases. This explains the reason for finding lipid abnormalities in several members of the same family.
  • Medical Conditions: There are various diseases and conditions which can cause dyslipidemia. Few of them include obesity, diabetes, hypothyroidism, chronic kidney disease, liver disease, etc.
  • Substance abuse: Dyslipidemia can also occur with substance abuse. few of the vices that could encourage dyslipidemia include alcoholism, heavy smoking, use of certain drugs, such as corticosteroids, beta-blockers, oral contraceptives, etc

When to See a Doctor?

An endocrinologist can be consulted if the patient experiences any of the following: 

  • Family history of heart disease or dyslipidemia
  • Unexplained chest pain or breathlessness.
  • Yellowish skin discolouration, indicating high cholesterol.
  • Manifestations of cardiovascular problems

Regular check-ups and blood tests can help in early detection and management of dyslipidemia.

Risk Factors of Dyslipidemia

Key risk factors for developing dyslipidemia include:

  • Age: Age is a non-modifiable risk factor for both cardiovascular diseases and dyslipidemia. The elderly patients are associated with raised triglycerides, raised LDL-C and raised non- HDL-C when compared with those of younger people. The risk increases with age, especially in men over 45 and women over 55.
  • Diet: High intake of processed and fatty foods can elevate cholesterol levels.
  • Climate: Patients living in extremely cold weather could lead to a higher consumption of foods. Additionally, cold weather can restrain people from performing sufficient outdoor physical activity and daily chores, resulting in a consequent high risk of obesity and dyslipidemia.
  • Obesity: Higher body mass index (BMI) is associated with lipid imbalances.
  • Smoking: patients from both from rural and urban areas had higher values of dyslipidemia drinking and smoking. Also, higher levels of hypertension is seen in these patients.  Tobacco use negatively impacts lipid profiles and increases cardiovascular risk

Complications & Preventions

Complications of untreated dyslipidemia can be serious, including:

  • Cardiovascular Disease: Dyslipidemia can increase cardiovascular diseases risk by promoting atherosclerosis and its complications. Dyslipidemia alters the function of the heart and the blood vessels by impairing the availability of nitric oxide.
  • Atherosclerosis: Dyslipidemia is the prominent factor which enhances the deposition of the fats in the arteries, thereby narrowing the diameter of the lumen and obstructing the blood transfer. The reduced blood supply results in the formation of thrombo-embolic episodes such as stroke, transient ischemic attack etc.
  • Pancreatitis: Hypertriglyceridemia is one of the major causes of acute pancreatitis, accounting for up to 10% of all cases. The pancreatitis which occurs due to hypertriglyceridemia is called hypertriglyceridemic pancreatitis and its pathology is still unclear.

Dyslipidemia Prevention Strategies

  • Healthy Diet: Incorporating fruits, vegetables, whole grains, and healthy fats while avoiding trans fats can help maintain healthy cholesterol levels.
  • Regular Exercise: Engaging in physical activity for at least 150 minutes weekly can improve lipid profiles.
  • Weight Management: Achieving and maintaining a healthy weight reduces the risk of dyslipidemia.
  • Dyslipidemia Screening: Routine blood tests to monitor lipid levels can aid in early detection and management.

Diagnosis and Tests

Dyslipidemia diagnosis typically involves:

  • Lipid Panel: This blood test is done to measure the specificity of the present in the blood. This group of tests measures multiple lipid substances, including several types of cholesterol containing molecules. This test can be done in all types of patients and does not include fasting. Through this test, the risk of cardiovascular diseases can be evaluated.
  • Medical History Review: Assessing family history and lifestyle factors can help identify potential causes. The endocrinologist could consider the possibility of a genetic disorder causing dyslipidemia and therefore could enquire about the health status of blood relatives if they suffer from either premature cardiovascular disease, lipid disorders, or are receiving lipid lowering medications. If the triglyceride levels are markedly elevated the doctor could enquire about family history of pancreatitis.
  • Physical Examination: An endocrinologist may check for physical signs of dyslipidemia, such as the presence of xanthomas (thickening of tendons due to accumulation of cholesterol), xanthelasma palpabrum (yellowish patches around the eyelids) and arcus senilis (white discoloration of the peripheral cornea)

Treatments for Dyslipidemia

  • Dyslipidemia treatment options may include:
  • Lifestyle Modifications: Dietary changes, increased physical activity, and weight loss are foundational to treatment.
  • Medications: Statins and other lipid-lowering medications may be prescribed to help manage cholesterol levels.
  • Surgical Options: In rare cases, procedures such as LDL apheresis may be considered for individuals with severe familial hypercholesterolemia

Do's and Don'ts for Dyslipidemia Management

Do’s:

  1. Monitor Lipid Levels: Regularly check your cholesterol and triglyceride levels through blood tests.
  2. Adopt a Healthy Diet: Focus on foods low in saturated and trans fats, such as fruits, vegetables, and whole grains.
  3. Exercise Regularly: Aim for at least 30 minutes of moderate exercise most days of the week.
  4. Manage Weight: Maintain a healthy weight to improve lipid profiles.

Don’ts:

  1. Avoid Processed Foods: Steer clear of foods high in trans fats, such as fried foods and commercial baked goods.
  2. Don’t Smoke: Quitting tobacco can significantly improve lipid levels and reduce cardiovascular risks.
  3. Limit Alcohol Intake: Excessive alcohol can raise triglyceride levels; moderation is key.
  4. Don’t Ignore Symptoms: Pay attention to any signs of cardiovascular issues and seek medical advice promptly.

Care at Dr. Prudwiraj Sanamandra Endocrinology Clinic

At Dr. Prudwiraj Sanamandra Endocrinology Clinic, patients receive specialized care tailored to managing dyslipidemia. Dr. Prudwiraj Sanamandra emphasizes a comprehensive approach, including detailed assessments, personalized treatment plans, and ongoing support for lifestyle modifications. His expertise ensures that individuals are empowered to take control of their health and achieve optimal lipid management.


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