Hyperlipidemia: Causes, Symptoms, Diagnosis & Treatment
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What is hyperlipidemia?
A condition known as hyperlipidemia is characterized by unusually high quantities of fats (lipids) in the blood. These lipids include cholesterol and triglycerides, among others.
Even though hyperlipidemia can be passed down via families, it is more frequently caused by factors related to lifestyles, such as an unhealthy diet and a lack of sufficient exercise.
High cholesterol is the most typical form of hyperlipidemia condition. Other types of hyperlipidemia include hypertriglyceridemia and mixed hyperlipidemia, the latter of which occurs when a person has elevated levels of both cholesterol and triglycerides.
Hyperlipidemia is a relatively frequent condition, especially in the wealthy nations of the modern world. It is also growing in prevalence all across the world.
There are 94 million people over the age of 20 in the United States who have excessive levels of total cholesterol, according to a trusted source. This constitutes approximately half of all adults in the United States.
People whose hyperlipidemia is not treated have a risk of coronary artery disease (CAD) that is two times higher than the risk that is posed to those whose cholesterol levels are within the normal range. This can result in the arteries becoming clogged, which can then lead to a heart attack, a stroke, or other significant complications.
However, hyperlipidemia is normally relatively controllable, and one can typically steer clear of situations requiring immediate medical attention. An early diagnosis and treatment plan are essential components in halting the disease’s progression.
Acquiring a Knowledge of Cholesterol
The fatty substance known as cholesterol is carried through your circulatory system by a class of proteins known as lipoproteins.
When there is an excessive amount of cholesterol in the circulation, it has the potential to accumulate on the walls of the blood vessels and turn into plaque. Plaque deposits, when left untreated, can gradually enlarge and cause artery blockage over time. The result of this could be:
coronary artery disease
attack of the heart or the stroke
vascular disease of the peripheral arteries, which can result in limb ischemia or gangrene
LDL and HDL cholesterol are the two distinct forms that cholesterol can take. It’s likely that someone has described them to you as “bad” and “good” cholesterol, respectively.
Your artery walls become rigid and constricted when LDL cholesterol, also known as “bad” cholesterol, accumulates there. HDL cholesterol, sometimes known as “good” cholesterol, is responsible for removing excess “bad” cholesterol and transporting it away from the arteries and back to the liver.
Reasons and potential hazards
A condition known as hyperlipidemia is characterized by an imbalance of cholesterol levels in the blood. This condition is brought on by a combination of factors, including having an excessive amount of LDL cholesterol and an insufficient amount of HDL cholesterol to clear it up.
Both inherited and acquired forms of hyperlipidemia are recognized as distinct subtypes of the condition. The familial form is caused by genes that are passed down from one generation to the next.
The acquired type is the consequence of the following:
conditions of health lurking beneath the surface
choices regarding your lifestyle and the medications you take
Most of the time, specific aspects of a person’s lifestyle are to blame for acquired hyperlipidemia. It is also possible that the medications you take or preexisting health conditions caused this issue.
Causes of hyperlipidemia that stem from lifestyle choices
Certain aspects of one’s way of life can contribute to higher levels of “bad” cholesterol and lower levels of “good” cholesterol.
According to the American Heart Association, a Reliable Source, the following are the primary aspects of one’s lifestyle that are associated with an increased risk of acquiring high cholesterol levels:
an imbalanced diet
a lack of physical activity smoking or being exposed to secondhand smoke on a frequent basis overweight or obesity
high use of alcohol (however there is some evidence that drinking red wine in moderation may have a protective effect)
Conditions of poor health that are associated with hyperlipidemia
High cholesterol can be caused or contributed to by a number of different health issues, including the following:
liver disease diabetes polycystic ovarian syndrome (PCOS) polycystic ovary syndrome (PCOS) underactive thyroid
Other illnesses that run in families and pregnancy are also potential contributors to elevated cholesterol levels.
Medications that are a factor in the development of hyperlipidemia.
There is a possibility that some medications, like the following, could have an effect on your cholesterol levels:
Pills used for birth control
antiretroviral corticosteroids that are used in the treatment of HIV
Beta-blockers only occasionally have an effect on cholesterol levels, and when they do, the change is typically insufficient to warrant discontinuing the medicine.
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Hyperlipidemia of the familial mixed type
Inherited mixed hyperlipidemia, also known as familial combination hyperlipidemia, is a kind of hyperlipidemia that can be passed down from either your parents or your grandparents. It leads to excessive levels of cholesterol as well as triglycerides in the blood.
It is common for individuals who have familial mixed hyperlipidemia to experience high cholesterol or high triglyceride levels by the time they are in their teens. These individuals typically do not acquire a diagnosis until they are in their 20s or 30s. This disorder significantly raises the risk of developing coronary artery disease and having a heart attack at an earlier age.
People who have familial mixed hyperlipidemia are more likely to have symptoms of cardiovascular disease at an earlier age than those who have conventional hyperlipidemia. These symptoms include the following.
discomfort in the chest at a young age
a young person who died of a heart attack
indications of stroke, such as difficulty speaking, drooping on one side of the face, or weakness in the limbs, including cramping in the calves while walking; sores on the toes that don’t heal properly; and
Indicators and manifestations
People who have hyperlipidemia typically do not experience any symptoms until the condition has progressed to the point where they are at risk for life-threatening complications like a heart attack or stroke. It is possible for them to develop when plaque has accumulated in your arteries as a result of elevated cholesterol, which then restricts or halts the flow of blood.
Your doctor and you will be able to determine the levels of cholesterol in your blood using a straightforward blood test.
The recommendations for 2018
According to a Reliable Source that was recently published in the Journal of the American College of Cardiology (JACC), a total blood cholesterol level that is above 240 milligrams per deciliter (mg/dL) is regarded as high, but values that are above 200 mg/dl are regarded as raised. However, this can change depending on a wide variety of conditions.
According to the recommendations of the CDCTrusted Source, you should get your cholesterol checked beginning at the age of 20, and then you should do the following:
more frequently than once every five years if you have risk factors for cardiovascular disease but only once every five years if your risk for cardiovascular disease is low.
There are circumstances in which examinations of youngsters and teenagers are acceptable. According to the Centers for Disease Control and Prevention (CDC), high cholesterol affects one in every five adolescents in the United States.
If any of the following apply, discuss the possibility of a cholesterol test with your child’s physician:
Your parents or grandparents both suffered from heart attacks or heart disease at a young age.
Your youngster has excess fat on their body or is obese.
Diabetes is affecting your child.
How the condition is identified
Because hyperlipidemia does not cause any symptoms, the only method to diagnose it is to have your doctor order a blood test that is known as a lipid panel or a lipid profile. A diagnosis of hyperlipidemia can be made based on the results of your lipid panel by your physician.
This test will reveal the levels of cholesterol in your body. After taking a sample of your blood and submitting it to a laboratory for analysis, a medical specialist will provide you with a comprehensive report on the findings. Your report will demonstrate your levels of the following:
triglycerides low-density lipoprotein total cholesterol (LDL) HDL cholesterol and high-density lipoprotein cholesterol (HDL) cholesterol \striglycerides
Before having your blood collected, your doctor may urge you to abstain from eating or drinking anything for eight to twelve hours. During that period of time, you won’t be able to consume anything other than water, since you’ll need to refrain from eating and drinking during that time. However, current studies suggest that it may not always be required to fast; therefore, it is important to follow the directions that your doctor gives you.
Cholesterol levels that are considered safe are best assessed in consultation with a medical professional because they can differ from person to person depending on their medical history and their current state of health.
Alterations to a patient’s way of life are the primary form of treatment for hyperlipidemia. In the event that these measures are insufficient, your doctor may recommend drugs to assist you in managing your high cholesterol levels.
Alterations to one’s way of life are frequently necessary in order to successfully manage hyperlipidemia at home. Even if you have familial mixed hyperlipidemia, which is a form of inherited hyperlipidemia, making adjustments to your lifestyle is still an important component of the treatment.
It’s possible that making just these few adjustments will be enough to significantly lower your risk of problems like heart disease and stroke.
If you are already using drugs to manage your hyperlipidemia, making adjustments to your lifestyle can increase the effectiveness of these medications in lowering cholesterol.
Consume a diet that is good for your heart.
If you make adjustments to your diet, you may see a decrease in your levels of LDL cholesterol and an increase in your levels of HDL cholesterol. You are able to make the following adjustments:
Pick fats that are better for you. Steer clear of saturated fats, which can be found in high concentrations in red meat, bacon, sausage, and full-fat dairy products, among other foods. When it is possible, choose leaner sources of protein such as chicken, turkey, and fish. When you cook, you should use monounsaturated fats like olive oil, avocado oil, and canola oil.
Remove any trans fats from your diet. Fried meals and processed foods, such as cookies, crackers, and other types of snacks, are two common sources of trans fats. Make sure you read the labels to find out what the product contains. Avoid buying anything that has the phrase “partially hydrogenated oil.”
Eat more omega-3s. The heart is one of the numerous organs that can benefit from omega-3 fatty acids. There are some fish that contain them, such as salmon, mackerel, and herring. You can find them in these fish. In addition to this, they can be found in some nuts and seeds, such as walnuts and flaxseeds.
Raise the amount of fiber in your diet. Insoluble fiber, which is found in oats, bran, fruits, beans, and vegetables, is the type of fiber that can help lower your LDL cholesterol levels. While all fiber is good for your heart, soluble fiber is especially beneficial.
Discover meals that are good for your heart. You can get advice on tasty meals, snacks, and desserts that won’t cause your cholesterol levels to rise by consulting the recipe page on the American Heart Association’s website.
Eat a greater variety of fruits and vegetables. They have a low percentage of saturated fat, in addition to being high in fiber and vitamin content.
Keep your weight at a level that is good for you.
If you have high body weight or are obese, decreasing weight may help reduce the amount of total cholesterol in your blood.
Finding out how many calories you are taking in vs how many calories you are burning is the first step in the weight loss process. To shed around one pound of fat, a typical adult has to reduce their daily caloric intake by 3,500 calories.
However, you don’t have to begin this process by yourself by any means. Along with increasing the amount of physical activity you perform, which will help you burn more calories than you take in, you can construct a nutrition plan that is tailored to your needs with the help of a qualified dietitian or a medical professional.
Get moving, if you possibly can.
The maintenance of a healthy weight, reduction in cholesterol levels, and overall health all benefit from regular exercise. Your high-density lipoprotein (HDL) cholesterol levels will suffer if you do not obtain sufficient amounts of exercise. This indicates that there is an insufficient amount of “good” cholesterol to transport the “bad” cholesterol out from the arteries in your body.
To see a reduction in your total cholesterol levels, you simply need to exercise for thirty to forty minutes at a moderate to strenuous intensity three or four times a week. The goal should be to accumulate a total of 150 minutes of physical activity each week.
This can take the form of anything that you find enjoyable, however include some of the following in your regular routine can help you get more exercise:
Consider riding a bike to work.
Take your dog on brisk walks around the neighborhood.
Do several lengths at the swimming pool in the area.
Join a fitness club (and make use of it!).
Instead of taking the elevator, you should use the steps.
If you take public transit, you should get off one or two stops earlier than normal.
Seek techniques to stop smoking
The level of “good” cholesterol in your blood is lowered by smoking, while the level of triglycerides rises. Even if you haven’t been given a diagnosis of hyperlipidemia, smoking can still raise your risk of developing cardiovascular disease.
Have a conversation with your primary care physician about stopping smoking, or give the nicotine patch a try. Nicotine patches are over-the-counter medications that may be purchased at any drugstore.
In the event that modifying your lifestyle is not sufficient to treat your hyperlipidemia, your physician may recommend medication.
In patients with hyperlipidemia, statins are typically the first medicine that is prescribed. mRNA and monoclonal antibody medicines have recently been developed as alternatives to statins for people who are unable to take statins or for whom they do not provide an adequate reduction in LDL cholesterol.
The following are examples of common drugs used to decrease cholesterol and triglycerides:
medications known as statins, such as atorvastatin (brand name: Lipitor) and fluvastatin (Lescol XL)
lovastatin (Altoprev) pitavastatin (Livalo) pravastatin (Pravachol)
resins that are capable of binding bile acids, such as cholestyramine (Prevalite)
Injectable alternatives to statins, such as ezetimibe (Zetia/Nexlizet), alirocumab (Praluent), or evolocumab; cholesterol absorption inhibitors, such as ezetimibe (Zetia/Nexlizet); (Repatha)
fibrates, like fenofibrate (Fenoglide, Tricor, Triglide) or gemfibrozil (Lopid)
omega-3 fatty acid supplements
alternative medications and supplements for decreasing cholesterol
There are new treatments available for high cholesterol.
Inclisiran is a novel medication that was developed using mRNA technology. It has received permission to be sold in Europe, but not in the United States as of yet.
In clinical trials conducted in 2020, the medicine shown an ability to reduce levels of LDL cholesterol by as much as fifty percent in patients who resisted or were intolerant to the effects of traditional statin treatments.
The cholesterol medicine inclisiran was the first of its kind to be developed using a technique known as “small interfering RNA treatment.” It is a sort of medication that prevents an RNA messenger from carrying out its function or otherwise disrupts it (mRNA). A molecule known as messenger RNA (mRNA) is one that contains the genetic instructions necessary to make a certain protein.
In the instance of inclisiran, the medication prevents the formation of an enzyme known as PCSK9, or it interferes with its development (proprotein convertase subtilisin kexin type 9). The LDL receptors in the liver, which are essential for the uptake of LDL cholesterol by liver cells, get disrupted as a result of the activity of this enzyme.
Inclisiran helps the body lower the total quantity of LDL cholesterol by inhibiting the action of a protein called PCSK9. The purpose of the medication is to treat hyperlipidemia in people whose high levels of LDL cholesterol continue to be elevated despite the fact that they are taking the highest possible dose of statin therapy.
Bempedoic acid (Nexlitol) and ezetimibe (Nexlizet)
First new non-statin cholesterol medications to be approved by the FDA since 2002, the pharmaceuticals Nexlitol and Nexlizet were given the green light in the year 2020 by the Food and Drug Administration.
The cholesterol-lowering effects of bempedoic acid, which is found in nexlitol, have been demonstrated in clinical trials. It is intended to be utilised in conjunction with the highest safe dosage of statins that can be administered.
Ezetimibe, which is found in Nexlizet, is the active ingredient that brings cholesterol levels down by stopping the body from absorbing cholesterol from diet. Additionally, it is meant to be taken concurrently with statins.
Both Nexlitol and Nexlizet have the potential to produce undesirable and even dangerous outcomes. Your physician will be able to assist you in determining whether or not one of these medications might be beneficial to your course of treatment.
In 2021, the FDA gave their blessing for Praluent (alirocumab) to be used as an additional treatment for familial hypercholesterolemia patients. This is a hereditary disorder that manifests itself in dangerously high cholesterol levels.
In 2015, the FDA gave its initial approval to Praluent as a treatment for cardiovascular disease as well as primary hereditary hyperlipidemia. It was the very first PCSK9 inhibitor that the FDA ever gave its blessing to.
Drugs known as PCSK9 inhibitors function by attaching themselves to the PCSK9 gene. This stops the gene from degrading LDL receptors in the liver, which in turn helps the body have lower levels of LDL cholesterol. In contrast to the recently developed mRNA medicine Inclirisan, inhibitors bind themselves directly to the PCSK9 gene, whereas the mRNA drug blocks the production of PCSK9 altogether.
The active ingredient of Praluent, which is known as alirocumab, is a monoclonal antibody. This is a laboratory-made protein that exhibits properties similar to those of antibodies naturally produced by the human body.
Praluent comes as a liquid solution in a prefilled pen. It is administered in the form of an injection once every two to four weeks, and this procedure can be performed at home. Because there have been multiple reports of potential adverse reactions to it, you should talk to your physician before deciding whether or not to include it in your treatment strategy.
How to avoid having high levels of cholesterol
You can lower your chance of developing hyperlipidemia and prevent high cholesterol by making adjustments to your way of life, namely the following:
If you can manage it, try to get some exercise on multiple days per week.
Consume less saturated and trans fats by changing your diet.
Make sure that a significant portion of your diet consists of fish, as well as a variety of vegetables and fruits, beans, nuts, and complete grains.
Reduce your consumption of processed meats and red meat, such as bacon, sausage, and cold cuts.
Keep your weight at a level that is appropriate for your health.
Consume a diet rich in unsaturated fats, such as those found in avocados, almonds, and olive oil.
You might want to consider following a diet that is good for your heart, such as the Mediterranean diet, which incorporates a significant number of the nutrient-dense foods described above.
Those with untreated hyperlipidemia have a more than twofold increased chance of getting coronary heart disease in comparison to those whose cholesterol levels are within the normal range. Coronary heart disease is a risk factor for a variety of major complications, including heart attack, stroke, and other issues.
Hyperlipidemia, on the other hand, is very amenable to treatment, and problems can frequently be avoided.
You might be able to avoid difficulties and bring your hyperlipidemia under control by adopting changes to your lifestyle, such as the following:
eating a diet that is both balanced and rich in nutrients, exercising frequently, not smoking, and maintaining a healthy weight for oneself is all important.
If the changes you make to your lifestyle are not enough, you and your physician might discuss the possibility of adding drugs, such as statins, that will assist you in bringing your cholesterol and triglyceride levels down to healthy ranges.