|
|
| General Illness Information |
Common Name: |
Hyperlipidemia,
Hypercholesterolemia |
|
Medical Term:
|
Hyperlipidemia |
| Description: |
Abnormally
high levels of fat in the blood.
Serum cholesterol higher than
200 mg/dL (5.18 mmol/L).
High risk: Serum cholesterol
higher than 240 mg/dL (6.22 mmol/L)
High density lipoprotein fraction of cholesterol (HDL) is
protective ["Good Cholesterol"]
Low density lipoprotein (LDL) is atherogenic ["bad
cholesterol"]
This is a serious and "silent" problem in North
America-
120 million people with cholesterol 200 mg/dL (5.18 mmol/L) or
more, 60 million with 240 mg/dL (6.22 mmol/L) or more.
|
| Causes: |
Primary:
Diet
Heredity
Obesity
Sedentary life-style
Stress
Secondary to other disorders:
Hypothyroidism
Diabetes mellitus
Nephrotic syndrome
Obstructive liver disease
Progestins
Anabolic steroids
Diuretics except indapamide.
Beta blockers except those with intrinsic sympathomimetic
activity (ISA)
Some immunosuppressants.
|
| Prevention: |
|
Eat a diet that is low
in fat.
Exercise regularly.
|
|
If you have diabetes,
adhere closely to your treatment program.
|
|
Get a medical test to
check your blood level of cholesterol and its fractions.
|
|
| Signs
& Symptoms |
|
Corneal arcus (whitish ring around the pupil)
before 50
Xanthomata, Xanthelasma ( fat deposits on
eyelids, face).
Arterial bruits ( loud arterial sounds,
denote arterial narrowing)
Claudication ( pain in extremity, on minimal
exertion)
Angina pectoris
Stroke
Myocardial infarction (Heart attack).
|
|
| Risk Factors |
|
Obesity
Heredity
Sedentary lifestyle
Lack of exercise.
|
| Diagnosis & Treatment |
|
For diagnosis, a laboratory blood study to
measure blood lipids. The patient must be fasting at
least 10 hours to obtain a valid lipid level.
Consumption
of caffeine prior to the test may increase the cholesterol
level.
|
| General
Measures: |
|
Requires intervention: HDL less
than 35 mg/dL (0.78 mmol/L), LDL greater than 160 mg/dL
(4.14 mmol/L) |
|
Recently, LDL acceptable levels have been
lowered by the American Heart Association, and these are
being correlated with cardiac risk factors of diabetes,
hypertension, coronary event, smoking, peripheral vascular
disease, severe obesity, strong family history, to initiate
treatment early. |
|
| Medications: |
|
Drugs of choice are a class of drugs termed as
"statins":
Fluvastatin (Lescol), lovastatin (Mevacor),
pravastatin (Pravachol), 20-40 mg per day, or cerivastatin (Baycol)
0.3-0.4 mg taken in evening. Effects: 20-40% LDL decrease,
decreases triglycerides.
Simvastatin (Zocor) 5-80 mg may decrease LDL 50%, raise HDL,
lower triglycerides
Atorvastatin (Lipitor)10-80 mg may be taken any time of
day, may decrease LDL 60%, also raises HDL and lowers
triglycerides
Liver function must be checked periodically.
|
|
| Activity: |
|
No restrictions
|
|
| Diet: |
|
A diet low in fats is
mandatory.
Reduce all dietary fats. Olive oil should be
preferentially used.
Increase fiber, increase intake of fruits,
vegetables, whole grains, and garlic
Emphasize, vegetarian, meatless, egg less,
cheese-less meals, with poultry, fish, and nonfat milk or
yogurt
Minimal daily alcohol use may increase HDL
Dietary adherence to low fat and
cholesterol generally may be expected to result in a 10% LDL
reduction
Intake of too many carbohydrates with a
high glycemic index, e.g., bread rice, pasta, potatoes, will
make weight loss and cholesterol reduction more difficult. |
|
| Possible
Complications : |
|
Coronary heart disease,
cerebrovascular disease, generalized arteriosclerosis. |
|
| Prognosis |
|
1% decrease in cholesterol results in 2% decreased
risk of coronary heart disease
Primary prevention of coronary artery disease is
very important, and includes dramatic reduction of LDL cholesterol,
and modification of all the coronary risk factors:
Diabetes, hypertension, previous coronary
event, smoking, peripheral vascular disease, severe obesity.
If treatment as above initiated early, with complete
compliance, risk of coronary event can be reduced
dramatically.
|
|