Hyperlipidemia

Hyperlipidemia is a mouthful, but it’s really just a fancy word for too many lipids – or fats – in the blood. It can be the result of any of several acquired or genetic disorders. More than 3 million people have this disorder in the United States and Europe.

What are cholesterol and triglycerides?

Cholesterol is a waxy, fat-like substance primarily produced by your liver. All the cells in your body use cholesterol as part of their cell membrane. Your skin uses sunlight and cholesterol to make Vitamin D. Your body also uses cholesterol to make hormones, and the liver uses cholesterol to make bile acid, which is needed to digest dietary fat. Triglycerides are consumed in our diets and also produced by the liver, and the body uses them for energy. Foods high in triglycerides are fatty foods, refined carbohydrates, foods high in simple sugars, and alcohol. Your liver needs to wrap these triglycerides in a protein strand in order to enable them to travel around the body and get to the sites where they are needed. The wrapped packages are then called lipoproteins, and the way the lipoproteins are “packed” determines what kind of lipoprotein it is. VLDL is the term for Very Low Density Lipoprotein, which indicates they are molecules stuffed full of cholesterol and triglycerides. Lipoproteins: VLDL, LDL and HDL and their roles The VLDL molecules travel around your body, delivering triglycerides to cells that use them for energy. When there are more VLDL than your body can use, it deposits the triglycerides—the excess fats— into your body’s fat stores. After VLDLs have dropped off their triglycerides, they become known as LDL, or low-density cholesterol, which are simply packages of cholesterol wrapped in a protein. These packages serve a purpose too, delivering cholesterol to sites where it is needed to build hormones or cell walls, for instance. However, this is also the type of cholesterol often referred to as “bad” or “lousy” cholesterol, because when it exists in your body in excess, it floats around in your bloodstream and causes problems. The more LDL is floating around in your blood, the more chances it has to lodge in damaged artery walls (hypertension, diabetes, and smoking are common causes of blood vessel damage), which over time can cause build up of “plaque” which narrows the arteries, restricting blood flow. When this build up happens in your coronary (heart) blood vessels, it is called coronary artery disease (CAD) and puts you at much greater risk of heart attack. Plaque in other arteries, such as the carotid artery in your neck, can decrease blood flow to the brain and increase risk of stroke. There is one more type of cholesterol on your blood panel. It is called HDL, or high-density lipoprotein. It has much more protein (the wrapping) and far less cholesterol and triglycerides on the inside of the package. This is because its job is to travel around, picking up stray, excess cholesterol from your cells and from the plaques in your blood vessels. This is why HDL is often called the “good cholesterol”. It’s the clean-up crew. HDL returns the extra cholesterol to your liver, which removes it from your body.

Cholesterol testing and your results

The National Institutes of Health recommend you have a blood test and fasting lipoprotein profile every 5 years. The total cholesterol goal should be 200 mg/dL. For most people, HDL should be 60 mg/dL or higher. Ideal LDL is 100 mg/dL and ideal fasting triglycerides are < 150 mg/dL. Your specific goals may vary depending on your specific health factors. Ask your doctor what your lipid goals should be.

What is the treatment?

Making healthy diet choices and increasing exercise are important first steps in lowering your high cholesterol. Depending on your overall risk, your doctor may also prescribe medication, however “the combination of diet and regular physical activity is important even if you’re on medication for high cholesterol,” said Dr. Vincent Bufalino, an American Heart Association volunteer. “It’s the most critical piece.” Consulting a doctor is important, since each condition has it quirks. For people with high triglycerides, for example, alcohol can be particularly dangerous. But for those with high cholesterol, a daily glass of wine or other alcohol, along with healthy eating and exercise, may actually help, Dr. Bufalino said.

Diet

If your triglycerides are high, you’ll want to eat a “heart healthy” diet, with lots of fruits and vegetables, and choose lean proteins.

Eat more produce. One of the most important things you can do is to fill half your plate at every meal with fruits and vegetables. Fresh produce is great, but canned (drained and rinsed) or frozen vegetables and fruits are fine choices too.

Minimize saturated fat intake and do your best to avoid trans fat. Saturated fats are found in red meats and whole dairy products, as well as some tropical oils such as coconut and palm. Change these fats out for more healthful choices: unsaturated fats such as olive oil and canola, and protein choices like fish, which contain higher levels of healthful fats, as well as legumes and nuts.

Trans fats are artificially created fats, and they are mostly found in processed foods, especially cakes and cookies. Food manufacturers are required to label any amounts of trans fats in excess of 1 g, but foods that show zero trans fats on the label can still contain some of these artificial, dangerous fats. Look for “hydrogenated” and “partially hydrogenated” on the label and avoid these foods. Margarine is a main culprit. Also, fried foods can have shockingly high saturated and trans fats. One dietitian investigating restaurant food found a small order of Jack in the Box Natural Cut fries contains 9 grams total fat, 4 grams saturated fat and 5 grams trans fat!

Increase the amount of fiber you eat. A diet high in fiber can help lower cholesterol levels by as much as 10 percent, Dr. Bufalino said.

Lose extra weight. A weight loss of 10 percent can go a long way to lowering your risk of or reversing hyperlipidemia.

Medication and Supplement Interventions

Statins—This class of drugs works in the liver to prevent the formation of cholesterol. Talk to your doctor about the possible side effects of statins before starting the drug.

Bile acid binders, or Resins—This class of LDL-lowering drugs works in the intestines by promoting increased disposal of cholesterol. Your body uses cholesterol to make bile, an acid used in the digestive process. These medicines bind to bile, so it can't be used during digestion. Your liver responds by making more bile. The more bile your liver makes, the more cholesterol it uses. That means less cholesterol is left to circulate through your bloodstream.

Niacin—This drug works in the liver by affecting the production of blood fats. Niacin side effects may include flushing, itching and stomach upset. Your liver functions may be closely monitored, as niacin can cause toxicity. Niacin is used cautiously in diabetic patients as it can raise blood sugar levels. Consult your doctor before starting any niacin therapy.

Fibrates—Fibrates are best at lowering triglycerides and in some cases increasing HDL (good cholesterol) levels. These drugs are not very effective in lowering LDL (bad) cholesterol.

Cholesterol absorption inhibitors—This relatively new class of cholesterol-lowering medications works by preventing the absorption of cholesterol from the intestine.

Omega-3 Fatty Acids Supplementation. Omega-3 fish oils or omega-3 fatty acids, are used in large doses to lower high triglyceride levels in the blood. Because the amount of omega-3 needed for significant triglyceride lowering (2 to 4 g) is difficult to attain through diet alone, supplementation with capsules may be needed. Use of these supplements should only be under the direction and care of a physician because large doses of marine-derived omega-3 may cause serious side effects, such as increased bleeding, hemorrhagic stroke and reduced blood sugar control in diabetics or interact negatively with other medications, herbal preparations and nutritional supplements. Individuals with allergies to fish and/or shellfish may have a severe adverse reaction to use of these supplements.

References:

http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Hyperlipidemia_UCM_434965_Article.jsp

http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_Article.jsp#.V7xpgvkrLIU