Lipid Disorders

 

Physicians use the term lipid disorders to describe several conditions in which high concentrations of lipids (fats) exist in the bloodstream. 

 

Lipid disorders can be caused by genetics, lifestyle, or a combination of both. 

 

Atherosclerosis, which is the buildup of fat and cholesterol-laden plaque in the walls of the heart's arteries, can result from cholesterol disorders. 

 

Lifestyle changes are important for treating lipid disorders. If the cause is genetic, or if lifestyle changes do not reduce the levels of fat in the bloodstream adequately, then a health-care provider may prescribe medications. 

 

Cholesterol, or lipid, is the scientific term for fats in the blood, and the term is used to describe fatty acids, neutral fats, waxes, and steroids. The two main types of lipids that affect heart disease are fatty acids and cholesterol. When three fatty acid molecules combine with glycerol, they form triglycerides; when they combine with cholesterol, they form cholesterol-esters; and combining with phosphorus makes phospholipids.

 

As people age, their coronary arteries can develop atherosclerosis, or hardening of the arteries, the buildup of fatty streaks and cholesterol-laden plaque in the artery walls. Coronary heart disease, or CHD, is diagnosed when the accumulation of plaque in a coronary artery grows large enough to obstruct blood flow to the heart.

 

Lipids do not dissolve in water. For cholesterol and fatty acids to be carried in the blood and used in cells, the body must use a kind of protein called apo-proteins to transport the lipids through the blood and into the cells. These protein-bound fats are called lipoproteins, and when physicians speak of lipid disorders, they generally refer to problems with the amounts of these lipoproteins in the blood.

 

Each lipoprotein contains cholesterol, cholesterol-esters, triglycerides, phospholipids, vitamins, and apoproteins. Lipoproteins are grouped into different classes based on their density, or how tightly packed together these different substances are. The lipoprotein classes include:

 

  • High density lipoproteins (HDL):  Called the good cholesterol, HDL picks up excess cholesterol in the blood and the body and carries it back to the liver, where it is broken down and removed from the body.

 

  • Low density lipoproteins (LDL):  Called the bad cholesterol, LDL carries cholesterol and deposits it in body tissues to be used for cell repair or for energy high levels of LDL.

 

  • Very low density lipoproteins (VLDL):  Made up mostly of a core of triglycerides, with small amounts of proteins and cholesterol, VLDL particles circulate in the blood, the triglycerides are absorbed by cells for energy, leaving the protein and cholesterol remnants.

 

Lipid disorders include:

 

  • Primary elevated cholesterol (LDL levels of more than 130 milligrams per deciliter, or mg/dL);
  • Dyslipidemic syndrome (also called Metabolic syndrome, a group of risk factors that significantly increases the risk of developing CHD);
  • Primary elevated triglycerides (triglyceride level as high as 1500 mg/dL);
  • Primary low-HDL syndromes (also called dyslipidemia or dyslipoproteinemia), in which HDL is less than 35 mg/dL;
  • Hyperlipidemia, or high cholesterol;
  • Familial hypercholesterolemia (a genetic disorder that increases total and LDL cholesterol); and
  • Familial hypertriglyceridemia, inherited high triglycerides.

 

 

CAUSES AND RISK FACTORS

 

Genetics and lifestyle can affect blood lipid levels. Some people suffer from lipid disorders that are a combination of genetic problems and lifestyle factors.

 

Lifestyle factors that can raise the cholesterol level include a diet high in fat and cholesterol-laden foods, and not exercising, which can lower the level of HDL in the blood.

 

Some people have lipid disorders caused by another disease or medical condition, called secondary lipid disorders, including:

 

  • Diabetes mellitus;
  • Hypothyroidism;
  • Obstructive liver disease; and
  • Kidney failure.

 

Lipid disorders can also be caused by steroid use.

 

 

DIAGNOSIS

 

To diagnose a lipid disorder, a physician tests the amount of lipids in a person's blood and compares the results to established ranges, which show whether a person's lipid level is abnormal enough to warrant treatment.

TREATMENT APPROACH

 

For people at high risk of heart disease or for people who have already developed coronary heart disease, typical target lipid levels are:

 

  • Total cholesterol of less than 200 mg/dL;
  • Total triglycerides of less than 150 mg/dL;
  • LDL of less than 100 mg/dL; and
  • HDL of 40 mg/dL or more

 

To reach these goals, physicians first recommend lifestyle modification, such as reducing dietary saturated fat and losing weight.

 

If lifestyle changes do not lower lipid levels sufficiently, physicians can prescribe lipid-lowering medications, including:

 

  • Statins
  • Bile acid sequestrants
  • Fibrates
  • Nicotinic Acide derivatives 

 

 

Metabolic Syndrome      

 

The metabolic syndrome is a cluster of risk factors that include abdominal obesity, abnormal cholesterol levels, elevated blood pressure, and elevated blood sugar. 

 

A person who has the metabolic syndrome has 5 times the risk of developing type 2 diabetes and 2 times the risk of having a heart attack or stroke. 

 

Insulin resistance and obesity may make a person more likely to develop the metabolic syndrome. 

  

Lifestyle changes, including weight loss, regular exercise, a healthy diet, and not smoking, are the most effective first-line treatments for the metabolic syndrome. 

 

The metabolic syndrome (also known as Syndrome X and insulin resistance syndrome) is a cluster of risk factors related to the body's metabolism that individually and collectively promotes the development of cardiovascular disease and type 2 diabetes mellitus. It confers a 5-fold increase in a person's risk of developing type 2 diabetes and doubles the risk of having a myocardial infarction (heart attack) or stroke.

 

 

WHAT ARE THE SYMPTOMS?

 

The metabolic syndrome typically has no symptoms.

 

 

CAUSES AND RISK FACTORS

 

It is unclear whether the metabolic syndrome has one single cause. Instead, researchers believe that certain risk factors make a person more likely to develop the metabolic syndrome, including:

 

  • Insulin resistance
  • Abdominal obesity
  • Age
  • Family history

 

 

DIAGNOSIS

 

A physician diagnoses the metabolic syndrome by taking a patient health history and performing a physical evaluation. Tests physicians use to diagnose the condition include:

 

  • Blood test (for glucose level and lipid levels);
  • Blood pressure and
  • Waistline measurement

 

A person has the metabolic syndrome if he or she has at least 3 of the following 5 risk factors:

 

  • Abdominal obesity
  • Elevated triglycerides
  • Low HDL cholesterol levels
  • Elevated blood pressure 
  • Elevated fasting glucose

 

Although each of these conditions is itself a risk factor for disease, when combined as the metabolic syndrome, they greatly increase the risk of heart disease and type 2 diabetes.

 

 

TREATMENT APPROACH

 

The main goal of treating a person with the metabolic syndrome is to lower his or her risk of developing heart disease and type 2 diabetes. Lifestyle changes are considered the most effective first-line treatments for the metabolic syndrome, and include:

 

  • Weight loss
  • Exercise
  • Diet
  • Quitting smoking

 

No one drug exists that can successfully treat the metabolic syndrome. However, a physician may prescribe one or more medications to treat the individual risk factors, including:

 

  • Lipid-lowering medications
  • Antihypertensive drugs
  • Weight-loss medications
  • Low-dose aspirin

 

 
 



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