Association of Cameroonian Physicians in the Americas

    DYSLIPIDEMIA

    dyslipidemi

    Cardiovascular disease (heart disease) is one of the leading causes of death among adults in the United states and patients with Dyslipidemia are at increased risk for developing heart disease along with other diseases.

    Dyslipidemia is a condition in which there is an abnormal elevation of cholesterol (fat) level in the blood. It is a disorder of lipid metabolism, related to increased production or delayed breakdown of atherogenic lipoprotein particles, or decreased synthesis or increased degradation of protective lipoproteins.

    To simplify this description; there are two types of lipoproteins, the good one (high density lipoprotein-HDL) which carries excess fat to the liver for it to be destroyed and sent out of the body as waste and the bad one (low density lipoprotein LDL or non-HDL cholesterol) which allows accumulation of fat in the blood vessels. Think of HDL as a trash bag that you use to throw non-HDL out of your body. Non-HDL cholesterol includes not just LDL but Triglycerides and other forms of lipoprotein as well. Dyslipidemia is the major precursor of lipid related diseases such as Atherosclerosis, Coronary artery disease and Ischemic stroke. 

    JUST A MOMENT…how does excess fat in one's blood result in heart disease?Enter heading here...

      It is a simple yet complex mechanism. The arteries (vessels which carry blood from the heart to the rest of the body) are normally smooth and unblocked inside. In the event of Dyslipidemia with increased LDL cholesterol levels, plaque (sticky substance) is formed inside the walls leading to a reduced opening for blood to flow through. As a result, there is narrowing and stiffening of the arteries(atherosclerosis) resulting in diseases like Coronary artery disease and Strokes.

    How is Dyslipidemia classified?

    Dyslipidemia can be classified using the World health organization/Fredrickson classification which breaks it down into Type I-V or by the clinical classification which breaks it down into Isolated hypercholesterolemia, mixed or combined dyslipidemia, Isolated hypertriglyceridemia or low HDL cholesterol. 

     What causes Dyslipidemia?

    Causes are broken down into two main types;

    • Primary Dyslipidemia [usually due to genetic problems affecting the production or breakdown of LDL or triglycerides].
    • Secondary Dyslipidemia [results from sedentary or poor lifestyle choices, excessive consumption of fatty foods, abdominal obesity and underlining disease like Diabetes, Hypothyroidism, Myxoedema, liver disease, chronic kidney failure, Nephrotic syndrome (a type of kidney disease), chronic Alcoholism or use of drugs like glucocorticoids (steroid medications), oral Estrogen, oral contraceptives (birth control pills), anabolic steroids, anti-HIV medications, atypical antipsychotics (for some types of psychiatric diseases) and certain beta blockers (medications for blood pressure)]

    More about the causes of Dyslipidemia…

    In this article we will concentrate on the secondary causes as they are more common

    For simplicity, consider the '4 Ds'

    • 1.Diseases as outlined above.
    • 2.Diets: Highly saturated cholesterol diets will cause mild Dyslipidemia. Such diets include bush faller staples like cheese, egg yolks, ice-cream, red meat, pastries, fried and processed foods. Let's not forget the paysan staples like Eru with a lot of oil, turning plantains/cocoyams with a lot of oil (born house planty) Kondre, Ndole, Ekwang, Achu soup with lots of palm oil and an extensive list of other Cameroonian/West African delicacies that are filled to the brim with oil. Bad news people, the now popular Keto diet puts you at risk of Dyslipidemia from a secondary cause!
    • 3.Drugs: Beta blockers like atenolol used to treat high blood pressure and other medications like amiodarone, oral contraceptives, corticosteroids and many other drugs will predispose to Dyslipidemia. Some of these medications cause reduced HDL production. Your doctor will modify your drugs based on the risks and benefits.
    • 4.Disorders of metabolism
    • However other factors like physical inactivity, cigarette smoking, weight gain especially in your abdomen and excess alcohol consumption will predispose an individual especially those with underlying genetic predisposition to develop Dyslipidemia.

    Signs and Symptoms

    Generally, the symptoms experienced occur as a result of the fat deposits in various organs

    • In the blood vessels non-HDL cholesterol results in atherosclerosis which can be felt as chest pain that results from the blockage of the heart vessels leading to a heart attack. If the blockage occurs in the vessels leading to the brain it can cause a stroke.
    • Non-HDL cholesterol at high levels may be deposited in tendons or beneath the skin or under the eyes or as multiple bumpy yellowish skin deposits (Xanthomas).
    • It can be stored in abdominal organs leading to swelling and damage of the organs such as the liver (hepatic steatosis AKA fatty liver), spleen and pancreas. 

    Diagnosis​

     A diagnosis of Dyslipidemia involves doing a simple blood test known as a fasting lipid panel which tells you and your doctor the levels of the different forms of lipids in the blood. Other tests may also be done to rule out other diseases like Hypothyroidism, kidney disease, Diabetes etc.

    Treatment

    The main goal in the management of Dyslipidemia is to reduce risk of atherosclerotic cardiovascular disease (ASCVD). That is reduce levels of non-HDL (bad) cholesterol and increase levels of HDL (good) cholesterol. This can be done by: -

    • Eating a diet low in saturated fats and cholesterol and high in unsaturated fats, dietary fiber and complex carbohydrates.
    • Drinking a 6-8-ounce glass of red wine 3-5 days a week
    • Doing aerobic exercises several times a week
    • Weight loss
    • Avoiding excessive alcohol intake
    • Stopping smoking
    • Prescription of medications that reduce non-HDL cholesterol like statins (Lipitor, Crestor, Pravachol. Other medications like Zetia and Questran can also be used if you cannot tolerate medications in the statin drug class due to symptoms like muscle aches. The type and intensity of anti-cholesterol medications are based on the type of patient, adverse effects and comorbidities.
    • Treatment of other comorbidities/diseases is also important

    What are the long-term complications?

    • Acute coronary syndrome (heart attack)
    • Ischemic stroke
    • Ischemic heart disease
    • Peripheral vascular disease (blockage of the blood vessels that supply blood to the arms and legs
    • Carotid artery blockage (blockage of the blood vessels that supply blood to the brain)
    • Abdominal aortic aneurysm (an enlargement of the large artery in your abdomen)
    • Erectile dysfunction

    Prevention is key

    • Lifestyle modifications like maintaining a healthy weight, reducing abdominal fat, exercising regularly, avoiding excess alcohol consumption and stopping cigarette smoking.
    • Also remember to consume diets low in saturated fats and cholesterol (like fried and oily foods) to avoid cholesterol abnormalities.
    • Instead eat foods high in unsaturated fats, dietary fiber (like vegetables, certain fruits and legumes) whole grains, oats, beans, peas.

    Author: Lucy Ndip Epse Ndep-Obi, MD

    Reviewer/editor: Shirley Ayuk-Takem, DO

    References:

    https://www.ncbi.nlm.nih.gov/pubmed/28978219

    https://www.ncbi.nlm.nih.gov/pubmed/8283927

    https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol

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