Hyperlipidemia

What is hyperlipidemia?

Lipid is the scientific term for fats in the blood. At proper levels, lipids perform important functions in your body, but can cause health problems if they are present in excess. The term hyperlipidemia means high lipid levels. Hyperlipidemia includes several conditions, but it usually means that you have high cholesterol and high triglyceride levels.
High lipid levels can speed up a process called atherosclerosis, or hardening of the arteries. Your arteries are normally smooth and unobstructed on the inside, but as you age, a sticky substance called plaque forms in the walls of your arteries. Plaque is made of lipids and other materials circulating in your blood. As more plaque builds up, your arteries can narrow and stiffen. Eventually, enough plaque may build up to reduce blood flow through your arteries.
Atherosclerosis increases your risk of heart disease, stroke, and other vascular diseases. Fortunately, you may be able to reduce high lipid levels and, therefore, prevent or slow the progression of atherosclerosis. Lifestyle changes like exercising and eating a healthy diet can also lower your lipid levels and are often the first step in treatment.

What are the symptoms?

Hyperlipidemia by itself does not cause any symptoms.

What causes hyperlipidemia?

Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions. Lifestyle contributors include obesity, not exercising, and smoking. Conditions that cause hyperlipidemia include diabetes, kidney disease, pregnancy, and an underactive thyroid gland.
You can also inherit hyperlipidemia. The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia.
You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55. If a close relative had early heart disease (father or brother affected before age 55, mother or sister affected before age 65), you also have an increased risk.

What tests will I need?

Because hyperlipidemia usually doesn't cause symptoms, you will need a blood test for a diagnosis. The National Cholesterol Education Program recommends that people get this test every 5 years after age 20.
Your blood test will show your physician the levels of different lipids in your blood. Your physician will compare your results to established ranges. The ranges help your physician diagnose hyperlipidemia and then decide whether you will need lifestyle modification, medical treatment, or both as treatments. Your physician will also determine whether you might have atherosclerosis or other risk factors for heart disease. The more risk factors for heart disease you have, the more aggressively your physician will treat hyperlipidemia.
Most blood tests measure levels of LDL (sometimes called "bad") cholesterol, HDL (sometimes called "good") cholesterol, total cholesterol (LDL plus HDL), and triglycerides. To have a low risk of heart disease, your desirable lipid levels are:

• LDL less than 130 mg/dL
• HDL greater than 40 mg/dL (men) or 50 mg/dL (women)
• Total cholesterol less than 200 mg/dL
• Triglycerides less than 200 mg/dL

Some experts believe that even lower cholesterol and triglyceride levels may be desirable.

How is hyperlipidemia treated?

Your treatment will depend on your lipid levels, your heart disease risk factors, and your general health. As a first step, your physician may recommend the lifestyle changes discussed later in this article.
Your physician's goal in treating you is to lower your LDL cholesterol. If lifestyle changes have not lowered your LDL, or if your physician decides that you are at risk for heart disease and you need stronger treatment than lifestyle changes, medications can help. In general, men older than age 35 and post-menopausal women are candidates for lipid-lowering medications.
Lipid-lowering medications include:

• Statin drugs, which prevent your liver from manufacturing cholesterol
• Bile acid sequestrants, which prevent your body from reabsorbing the cholesterol in bile. Bile is a liquid secreted into your small intestine that helps you digest dietary fats
• Fibrates
• Niacin (vitamin B5)

What can I do to stay healthy?

Physicians usually recommend making changes in your diet and exercise habits called therapeutic lifestyle changes (TLC). TLC can lower total cholesterol by 10 to 20 percent in some people. More commonly, however, people with hyperlipidemia experience a 2 to 6 percent reduction from TLC.
A major part of TLC is changing your diet. Your physician may recommend changes such as:

• Reducing your saturated fat intake to 7 percent of your daily calories
• Reducing your total fat intake to 25 to 35 percent of your daily calories
• Limiting your dietary cholesterol to less than 200 mg per day
• Eating 20 to 30 g a day of soluble fiber, which is found in oats, peas, beans, and certain fruits
• Increasing your intake of plant stanols or sterols, substances found in nuts, vegetable oils, corn and rice, to 2 to 3 g daily

Other foods that can help control cholesterol include cold-water fish, such as mackerel, sardines, and salmon. These fish contain omega-3 fatty acids that may lower triglycerides. Soybeans found in tofu, soy nuts and many meat substitutes contain a powerful antioxidant that can lower LDL.
A supplement known as psyllium can help you increase your soluble fiber intake. Made from seed grain husks, psyllium helps absorb water and cholesterol from your intestines and may improve the ratio of HDL to LDL.
Excess weight can decrease your HDL cholesterol, and losing excess weight can lower your LDL levels. Your physician will help you decide how much weight you need to lose. One consideration, though, is body shape. If you carry extra weight around the middle of your body, you have a greater chance of heart disease than if your weight clusters around your hips, thighs, and bottom.
Exercise makes up another component of TLC. Your physician will recommend an exercise program, such as walking briskly for 20 to 30 minutes most days of the week. Exercise can help you lose or maintain weight, relieve stress, raise HDL, and lower triglycerides and LDL. Make sure to talk with your physician before starting any exercise program and gradually increase how long and how often you exercise.
If you smoke, you should quit immediately, especially after finding out you have hyperlipidemia. Smoking can lower HDL, narrow your blood vessels, and injure your blood vessel walls. All of these effects can speed hardening of the arteries.

Diabetes Mellitus

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.

When our food is digested the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, and lowers the blood sugar level.

A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.
Why is it called Diabetes Mellitus?

Diabetes comes from Greek, and it means a siphon. Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the Medieval Latin diabetes.

In 1675 Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means honey; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water".

In ancient China people observed that ants would be attracted to some people's urine, because it was sweet. The term "Sweet Urine Disease" was coined.

There are three main types of diabetes:

Diabetes Type 1 - You produce no insulin at all.
Diabetes Type 2 - You don't produce enough insulin, or your insulin is not working properly.
Gestational Diabetes - You develop diabetes just during your pregnancy.
(World Health Organization)

Diabetes Types 1 and 2 are chronic medical conditions - this means that they are persistent and perpetual. Gestational Diabetes usually resolves itself after the birth of the child.

Treatment is effective and important

All types of diabetes are treatable, however Type 1 and Type 2 diabetes last a lifetime; there is no known cure. The patient receives regular insulin, which became medically available in 1921. The treatment for a patient with Type 1 is mainly injected insulin, plus some dietary and exercise adherence.

Patients with Type 2 diabetes are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.

If diabetes is not adequately controlled the patient has a significantly higher risk of developing complications, such as hypoglycemia, ketoacidosis, and nonketotic hypersosmolar coma. Longer term complications could be cardiovascular disease, retinal damage, chronic kidney failure, nerve damage, poor healing of wounds, gangrene on the feet which may lead to amputation, and erectile dysfunction.

What is high blood pressure (hypertension)?

High blood pressure (hypertension) affects more than 45 million Americans and is the commonest reason by an adult to visit the physician's office. Hypertension is a medical term used to describe increased pressure in the arterial system that transports blood from the heart to rest of the body. It is the force exerted by flowing blood on the wall of the arteries. Blood pressure originates mainly from a combination pumping force of the heart and resistance of the blood vessels to flow. Blood pressure is expressed as two numbers, systolic blood pressure and diastolic blood pressure. The systolic blood pressure is caused at the time of pumping of the heart and is higher number than diastolic blood pressure which occurs during the relaxation phase of the heart's pumping cycle. Systolic blood pressure usually written above the diastolic blood pressure (like 130/85). The values are expressed as mm of mercury. In the previous example the systolic blood pressure is said to be 130 mm of mercury and the diastolic pressure is 85 mm of mercury. When one is having blood pressure above the normal limit he or she is said to have hypertension or high blood pressure.
The following table explains normal and abnormal blood pressure

Condition	Systolic blood pressure	Diastolic blood pressure
Normal	Less than 120	Less than 80
Pre-hypertension	120 to 139	80 to 89
Stage 1 hypertension	140 to 159	90 to 99
Stage 2 hypertension	160 or higher	100 or higher

Comments: Among systolic and diastolic values, the value that is most abnormal will be used for the assessment of stage of hypertension (for example if systolic blood pressure is 138 and diastolic blood pressure is 101 he or she has stage 2 hypertension).

What causes high blood pressure?
The exact reason why most people develop high blood pressure is unknown. However in about 2% of patients with hypertension a cause may be found. The causes in these people may include disease of the kidneys or adrenal glands. People with high blood pressure from these causes often may have significantly high levels of blood pressure. Diseases of thyroid glands cause also cause high blood pressure. Coarctation of aorta, (a congenital narrowing of the aorta in the chest) may be associated with increased blood pressure in the hands with decrease blood pressure in the legs. It is important to understand that in about 98% percentage of people with high blood pressure no cause can be found.
What are the risk factors for hypertension?
The following are risk factors for developing hypertension

• Having close relative with hypertension
• Male gender
• Black race
• Age above 35 years
• Diabetes
• Kidney disease
• Smoking
• Obesity
• Sleep apnea
• Taking oral contraceptive pills
• Excess alcohol use
• Lack of exercise

Can I decrease my chances of developing high blood pressure?
The answer is "yes". There are several things that can decrease your chances of developing high blood pressure. These include:

• Develop a healthy eating habit
• Maintain ideal body weight
• Have a regular exercise program
• Keep alcohol to moderation
• Reduce salt intake in your diet
• Stop smoking

OK! I have high blood pressure. Why should I bother?
High blood pressure causes damage to the blood vessels. High blood pressure can increase your risk of having a heart attack or stroke. It can cause extra stress to your heart, which can eventually fail to perform its function adequately (a condition known as heart failure). It can cause damage to kidneys causing decreased efficiency of renal function. It can also cause some neurologic and cardiovascular diseases:

• Neurologic - Hypertensive encephalopathy, cerebral vascular accident/cerebral infarction. subarachnoid hemorrhage, intracranial hemorrhage
• Cardiovascular - Myocardial ischemia/infarction, acute left ventricular dysfunction, acute pulmonary edema, aortic dissection
• Other - Retinopathy, eclampsia, microangiopathic hemolytic anemia

I have high blood pressure. What should I do about it?
As mentioned above, untreated blood pressure can damage organs like kidney, heart or brain hence it is essential that you take measures to lower the blood pressure and minimize potential damage from other harmful living habits. Maintaining ideal body weight and having a regular program of exercise are integral parts of the treatment of high blood pressure. You should resort to healthy eating habits and cut down on fat. You should abstain from smoking and limit your alcohol intake to moderation. Many times the control of high blood pressure may require use of medications. The medications should be continued as long as your blood pressure remains high. With life style modifications your blood pressure may disappear and you may be able to stop taking the medications.