Dyslipidemia is simply a disorder of the lipid metabolism. Dyslipidemia is a very broad term that includes abnormalities in the amount, structure or function of individual lipid fractions. What are the causes and symptoms of dyslipidemia? How is the treatment going?

Dyslipidemiasare associated with an increased risk of cardiovascular diseases - they are the direct cause of the development of atherosclerosis, which leads to ischemic heart disease, ischemic strokes or lower limb ischemia. The severity of dyslipidemia is evidenced by numerous guidelines and recommendations, which have been published more and more frequently in recent years, and which are aimed at combating this problem. One of the examples is our national Sopot Declaration, which defines the rules of conduct in dyslipidemia, including, among others, prevention, diagnosis and treatment.

Contents:

  1. Dyslipidemia - what are lipids?
  2. Dyslipidemie - types of-dyslipidemia
  3. Dyslipidemia - causes. How does dyslipidemia develop?
  4. Dyslipidemia - treatment

Dyslipidemia - what are lipids?

Lipids in the chemical sense are actually lipoproteins, because their molecules are made not only of fats, but also of proteins, among others. Lipoproteins consist of a lipid core which is insoluble in water (hydrophobic) and which consists mainly of cholesterol esters and triglycerides. The core comprises a water-soluble, hydrophilic shell, mainly composed of phospholipids, cholesterol and so-called apolipoproteins. Different apolipoproteins are found in different lipoprotein fractions. What do we need lipids for? In lipoproteins, exogenous and endogenous cholesterol is transported to various tissues of our body, where it is used, inter alia, to build normal cell membranes, synthesize bile acids and steroid hormones. We can distinguish several types of lipoproteins, including chylomicrons, very low (VLDL), low (LDL) and high density (HDL) lipoproteins. The vast majority of chylomicrons are composed of triglycerides, similar to very low density lipoproteins. In plasma, VLDL are converted to LDL. The latter consist mainly of cholesterol esters and it is their concentration that is of greatest importance in the development of atherosclerosis. The last of the lipoproteins,or HDLs are so-called "good cholesterol" because they mainly trap and collect excess free cholesterol from the circulating blood, and then transport it to the liver.

Dyslipidemia - types of dyslipidemia

The most popular is the division of dyslipidemia into three categories:

  1. pure cholesterolemia - in which the concentration of total cholesterol and LDL fraction increases
  2. hypertriglyceridemia - where we observe an increase in the level of triglycerides and VLDL
  3. mixed hyperlipidemia - which is a combination of both

Are all dyslipidemias dangerous to our he alth? Currently, it is believed that the most important from the point of view of the pathophysiology of atherosclerosis are hypercholesterolemia, mixed dyslipidaemia and a disorder called atherogenic dyslipidemia, the main components of which are the increase in triglyceride levels and the simultaneous decrease in HDL levels, which play a certain protective function in our body against the development of atherosclerosis.

Dyslipidemia - causes. How does dyslipidemia develop?

Dyslipidemia can be primary or secondary. Primary dyslipidemia develops as a result of an improper diet and generally understood "unhe althy lifestyle". This means that people who consume an excessive amount of animal fats, and too little of he althy, i.e. vegetable fats, are primarily exposed to the development of dyslipidemia. In addition, smoking, a sedentary lifestyle and alcohol abuse also contribute to the development of primary dyslipidemia.

Sometimes, unfortunately, dyslipidemia develops genetically. Then even a person who leads a he althy lifestyle will be at risk of developing dyslipidemia.

Secondary dyslipidemia may develop with

  • hypothyroidism
  • pregnant
  • Cushing's syndrome
  • nephrotic syndrome

or as a result of chronic use of certain medications, such as immunosuppressants, glucocorticosteroids, or progestogens.

Diabetes and metabolic syndrome as well as diseases with cholestasis in the biliary tract also predispose to the development of dyslipidemia.

Dyslipidemia - treatment

Treatment of dyslipidemia can be both non-pharmacological and pharmacological. When and which ones to use should always be determined by the individual's cardiovascular risk and age. The main point of reference in the treatment of dyslipidemia should be the concentration of LDL, as numerous studies have shown that it is this fraction of lipoproteins that best reflects the effects oftherapy. In all patients, at every stage of treatment, the basis should always be non-pharmacological treatment, which includes:

  • gradual weight loss in all people diagnosed with overweight or obesity and maintaining a he althy weight in the rest
  • active lifestyle, defined as a minimum 30-minute, moderate effort at least five times a week
  • a diet in which fats account for 25-35 percent supplied to the body with energy meals, and polyunsaturated fats with a predominance of omega-3 over omega-6 are preferred,
  • reduction of animal fats and simple sugars
  • eating lots of vegetables
  • meals containing fish at least twice a week
  • avoiding smoking, drinking alcohol and limiting the consumption of sodium chloride
  • in some cases taking dietary supplements that have proven to lower cardiovascular risk, such as phytosterols, red rice yeast or omega-3 fatty acids

Although non-pharmacological treatment is the basis for the management of dyslipidemias, it is usually not sufficient and pharmacotherapy must be added to it. The most commonly used are statins, because apart from lipid-lowering activity, they also have a number of other benefits, so as long as there are no contraindications, they should be included in the therapy. Other drugs that are used in dyslipidemia are ezetimibe, PCSK9 inhibitors, fibrates and omega-3 acids.

Sometimes combination therapy is necessary to obtain a satisfactory therapeutic effect. The effect of statins depends on the dose used, and is best defined by the well-known Roberts' rule, which says that each doubling of the daily dose of a statin can reduce LDL concentration by about 6%. Statins are the best choice for dyslipidemia because many studies have shown that they reduce the risk of cardiovascular events and reduce the number of deaths. When it comes to their side effects, the most common of them is muscle and liver damage, therefore liver parameters should be monitored before and during treatment with statins.

In dyslipidemia, the most powerful of the statins, i.e. atorvastatin and rosuvastatin, are most often used. However, only atorvastatin is recommended for patients with advanced-stage chronic kidney disease. If we are dealing with severe hypetriglyceridemia, fibrates will probably be the best choice because they reducelipoprotein fraction. Ezetimibe and PCCK-9 inhibitors can be used in combination therapy or monotherapy with elevated LDL levels, when statins are contraindicated or ineffective.

Category:

Cardiology