Hyperlipidemia mainly affects the cardiovascular system. High levels of plasma lipids result in high levels of LDL. These are deposited in the lumen of medium and large-sized arteries affecting their function. The excess lipids and fats can also be deposited on the coronary artery resulting in coronary heart disease (CHD). CHD could lead to chest pains and heart attack, damaging heart muscles.
Normal Anatomy and Physiology of Body System Affected
The average diameter of arteries before deposition of fat is larger than after deposition. The diameter is adequate to allow for blood flow. Coronary artery, for instance, has a luminal diameter of approximately 4.6 millimeters (Nelson, 2013). Hyperlipidemia which causes deposition of fats in arteries results in the narrowing of the lumen of arteries.
The average levels of blood fats in milligrams per deciliter slightly varies between the two genders. Normal HDL cholesterol levels are 40mg/dl in males and 50 mg/dl in females. Normal LDL cholesterol level should be less than 130mg/dl. For diabetics and individuals with heart disease, the LDL levels should be below 100mg/dl. Normal blood TGs level should be less than 150mg/dl. The total cholesterol level should be lower than 200mg/dl. Higher levels could imply the presence of a disease (Shattat, 2014).
Pathophysiology
The primary plasma lipids comprise triglycerides, cholesterol, and phospholipids. Cholesterol is essential in the body for the synthesis of steroid hormones and bile acids, and also in the maintenance of cell wall integrity. Cholesterol is mainly found in cells. Only about 7 percent is in serum. Serum cholesterol is the one which has been found to cause atherosclerosis (Nelson, 2013). Triglycerides comprise glycerol and fatty acids and are an essential source of stored energy. Phospholipids are involved in lipid transport and cell function. Lipids are usually combined with proteins to enable them to be transported in the blood as they are water insoluble.
Lipoproteins are synthesized in the intestines and the liver. Endogenous production is mainly by the liver. Lipoproteins possess a hydrophilic and a hydrophobic end. The hydrophilic end comprises phospholipids and apolipoproteins. Apolipoproteins are specialized proteins whose role is to determine the particular receptors that lipoproteins will bind. They control the metabolism and interactions of lipoproteins. Hence, they have a role in the prevention and development of hyperlipidemia (Nelson, 2013).
Prevention
The prevention of hyperlipidemia is mainly by avoidance of risk factors. Some risk factors are related to diet and lifestyle. For secondary hyperlipidemia especially, avoidance of the risk factors could prevent its development.
Taking a balanced and healthy diet is essential for the prevention of hyperlipidemia (Shattat, 2014). The diet should be rich in vegetables, fibers, and fruits and low in cholesterol. Alcohol intake should be reduced or abolished altogether. Also, cessation of smoking or not engaging in smoking can prevent hyperlipidemia.
Engaging in physical exercises such as jogging is useful in the prevention of hyperlipidemia. The reason is that exercise is helpful in the prevention of hyperlipidemia as, during exercise, triglycerides are broken down into fatty acids and glycerol which are metabolized to produce energy, thereby lowering their level (Nelson, 2013).
Treatment
Hyperlipidemia can be treated by weight loss, making dietary changes, and exercise. Medications can also be prescribed to lower LDL levels. The type and dosage of medication will depend on the particular type of lipid and diabetes, heart disease or any other risk factor.
Before treatment, it is essential to assess the quantities of the following body mass index, blood pressure, transaminase levels, renal function, thyroid stimulating hormone, HDL, LDL, and total cholesterol.
Lifestyle modification entails increasing physical exercises, cessation of smoking, and dietary changes. The dietary modifications involve a reduction of fat intake by up to 30 percent such that less the consumption of cholesterol is below 300 milligrams in a day (Shattat, 2014).
The preferred class of drugs used in the treatment of hyperlipidemia is statins. They include lovastatin, pravastatin, simvastatin, rosuvastatin, atorvastatin, and fluvastatin. Their mode of action is by inhibiting HMG-coenzyme A reductase which catalyzes the rate-limiting step in the biosynthesis of lipids in the liver. The effect of this is a reduction of plasma lipids level, mainly triglycerides (TGs) and LDLs. It also elevates HDL levels (Hippel, 2013).
Other classes of drugs used to treat hyperlipidemia are fibric acid derivatives, bile acid binding resins, cholesterol absorption inhibitors, and nicotinic acid derivatives. All these decrease LDL and TGs level and elevate HDL levels except nicotinic acid derivatives that lower only LDL cholesterol levels (Shattat, 2014).
Clinical Relevance
In atherosclerosis, hyperlipidemia is the leading risk factor. Atherosclerosis is a disease process where cholesterol, lipids, and calcium accumulate and develop into fibrous plaques on arterial walls. Atherosclerosis has been implicated in the causation of some cardiovascular disorders including ischemic stroke, coronary artery disease, and myocardial infarction (Nelson, 2013).
It is crucial to understand that not all types of hyperlipidemia are similar and hence their treatment will differ (Shattat, 2014). The treatment of simple lipid disorders differs from that of complex disorders which may necessitate treatment by an endocrinologist.
References
Krishna N, C. (2017). The study of non-HDL cholesterol levels compared to LDL cholesterol levels in diabetics. Journal Of Medical Science And Clinical Research, 05(03), 18716-18723. http://dx.doi.org/10.18535/jmscr/v5i3.72
Nelson, R. (2013). Hyperlipidemia as a risk factor for cardiovascular disease. Primary Care: Clinics in Office Practice, 40(1), 195-211. http://dx.doi.org/10.1016/j.pop.2012.11.003
Shattat, G. (2014). A Review article on hyperlipidemia: types, treatments and new drug targets. Biomedical and Pharmacology Journal, 7(2), 399-409. http://dx.doi.org/10.13005/bpj/504
Von Hippel, P. (2013). Statin therapy for hyperlipidemia. JAMA, 310(11), 1185. http://dx.doi.org/10.1001/jama.2013.276740
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