Hyperlipidemia

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.