Hypercholesterolaemia (changes in cholesterol and other fats)

Overview :

Fats are an important part of the diet. Most fats ingested with food are called triglycerides and, to a lesser extent, cholesterol and phospholipids. These fats will be absorbed in the small intestine and then be used to form the membranes of every cell in our body (cholesterol and phospholipids), make hormones and bile (cholesterol), used as fuel in our adipose tissue in our muscle (triglycerides) and activate blood clotting (phospholipids).

Besides its origin in the food we eat, our body fats are also produced in the liver (cholesterol and triglycerides), this happens when we are not eating or starvation situations.

However, these fats as such can not circulate in the blood. Recall that if we take a glass water and oil do not mix both substances but remain separate (“rejected”). The same would apply if the blood (which is basically water). So fats circulating in our blood “protected” by a protein coat that serves as shield and allows this “fat” to reach all tissues to perform the functions to which we referred earlier. The whole of the fat and protein called lipoprotein that transports.

Different lipoproteins, being known LDL and HDL, but not unique. The importance of these two lipoproteins is its association with cholesterol levels in blood and his close relationship with the occurrence of cardiovascular disease. The LDL cholesterol which are distributed from the liver and reaches all tissues and is also deposited in the arterial wall, is associated with increased risk of atherosclerosis and cardiovascular diseases, for what is popularly known as “bad” cholesterol . While remaining HDL carry cholesterol from the artery wall and from body tissues to the liver for disposal or reuse; HDL protect us against the development of atherosclerosis and cardiovascular disease, so that transport cholesterol called HDL as “good” cholesterol.Although from a scientific standpoint, the “bad” cholesterol is essential to life, such as water or oxygen is only “bad” if it is in excess amounts in our bodies.

Other transport lipoprotein triglycerides in the case of chylomicrons and VLDL. Its function is to transport triglycerides muscle and adipose tissue where they will consume or store until use.

Fats, once used, are removed from the body or reused, and they do so mainly through the liver.

If a person has, for example, an inability to remove cholesterol, to give a blood test will see that their cholesterol levels are very high. So if, for example, your intestine absorbs large amounts of cholesterol. At other times it is elevated blood triglycerides are. A third situation is when cholesterol levels are low. Finally, we can find a combination of these situations.

For all we know these changes globally as dyslipidemia, which will translate into a change in the concentrations or levels of blood fats. When figures are high blood cholesterol hypercholesterolemia talk about. When triglyceride levels are high talk of hypertriglyceridemia. And when there is a combination of both speak of mixed dyslipidemia. We will also consider a number of low HDL cholesterol or hypoalphalipoproteinemia.

Hypercholesterolemia is increased blood cholesterol level above normal values. When we talk about hipercolesteroleromia we mean, by default, going to cholesterol within LDL or “bad” cholesterol. Normal values ​​of cholesterol (total) establish below the 200 mg / dL (= 5’2 mmol / L). Normal values ​​of LDL cholesterol will be defined according to that individual’s cardiovascular risk. There is no amount of LDL cholesterol in the blood below which the individual is fully protected from cardiovascular disease. In an individual where there are other risk factors for cardiovascular disease (eg, diabetes, hypertension, or smoking), figures lower LDL cholesterol may be more harmful than another individual without the same risk factors. In general, therefore, the greater the risk of an individual, the lower should be the amount of LDL cholesterol. In epidemiological terms and cardiovascular risk reduction should ideally always our LDL cholesterol was below 130 mg / dL (= 3’4 mmol / L).

Hypertriglyceridemia is increased blood triglyceride level above normal values. As for cholesterol, no one figure of normal boundary. But based on the cardiovascular risk associated establish as having a normal triglycerides below 150 mg / dL (= 1.7 mmol / L), and from the point of view of the risk of pancreatitis, triglyceride levels should never exceed 400 mg / dL (= 4.5 mmol / L).

Hypoalphalipoproteinemia is decreasing HDL cholesterol in the blood. Studies indicate that the normal values ​​of HDL cholesterol are figures above 40 mg / dL (= 1.0 mmol / L).

How does it occur ?

The causes of failures occur in the concentrations of these fats are divided into two groups: first, the so-called root causes, including alterations in certain genes that control absorption pathways, manufacture and disposal of fats and, secondly, that we call secondary causes for dyslipidemia are secondary to the presence of certain diseases, the consumption of drugs or lifestyle habits such as smoking, alcohol, physical inactivity and obesity. In some individuals may be present both types of alterations.

In what situations or diseases is increased LDL cholesterol?

The genetic disease that occurs more frequently is increased cholesterol familial hypercholesterolemia, which is due to a mutation in the gene encoding the LDL receptor of liver, so that LDL can not be removed from the bloodstream. Another GE also prevents LDL are removed from the blood is the deficit of apolipoprotein B100 family. Within the secondary or genetic causes, blood cholesterol can be raised by the consumption of a diet rich in animal fats, by the intake of some drugs (for example, certain diuretics) and for the presence of disease thyroid (hypothyroidism), kidney (nafrótico syndrome) or liver (cholestasis).

What conditions or diseases are increased triglycerides?

Factors such as our lifestyle and alcohol consumption of diets rich in bakery products can cause increased blood triglycerides. Certain diseases such as type 2 diabetes mellitus, obesity, chronic renal failure and hepatitis are also secondary cause of elevated triglycerides. Just as some drugs such as estrogens, beta-blockers, resins and retinoic acid. Pregnant women may also have high levels of triglycerides. Genetic causes that increase triglycerides are less common, and among them we should mention the lack of a protein that breaks VLDL and called lipoprotein lipase, or familial combined hyperlipidemia.

What conditions or diseases are increased cholesterol and triglycerides?

Among the causes are the primary genetic or familial combined hyperlipidemia (which can also appear increases without increasing cholesterol and triglycerides increases without increasing cholesterol triglycerides) and type III hyperlipidemia (where there is always increased cholesterol and triglycerides).Secondary causes must cite any combination of the increased cholesterol producing and producing increased triglycerides.

In what situations or disease is decreased HDL cholesterol?

There are genetic causes due to mutations in genes encoding certain proteins critical for the synthesis and removal of HDL, such as familial hypoalphalipoproteinemia (common) or Tangier disease (rare). Secondary causes that decrease in HDL cholesterol are diet rich pastries and refined sugars, obesity, type 2 diabetes mellitus and smoking.

Symptoms

Cholesterol (both HDL “good” and “bad”) no symptoms itself. An individual may have a high numbers of LDL cholesterol and certain that these figures do not cause any symptoms, even a simple headache. However, those numbers will go higher gradually damaging the wall of your arteries (the arteries that carry blood to the heart, the arteries that carry blood to the legs, the neck arteries that carry blood to brain, aorta, arteries that carry blood to the kidney and other arteries) to finally cause an obstruction to the passage of blood through these organs, or even a severe weakening of the artery wall (aneurysm). Depending on the location of clogging arteries, the patient may have heart disease (angina pectoris, myocardial infarction or heart failure), cerebral thrombosis, chronic renal insufficiency, arterial disease of the lower extremities (intermittent claudication, gangrene), or abdominal aneurysm.

Cholesterol is also deposited in other tissues, such as skin, tendons and eyelids, and called xanthomas, or corneal, and is called corneal arcus. In these cases the accumulation of cholesterol occurs only cosmetic problems.

HDL cholesterol, when it is low, does not give symptoms but it will not be enough to remove cholesterol from the bloodstream and thus will contribute to these cardiovascular events mentioned above.

Moderately high triglycerides also give symptoms but help accelerate the development of cardiovascular problems. However, the figures should be considered high or very high triglycerides, and which cause acute pancreatitis is an acute inflammation of the pancreas which can be fatal. In this case the symptoms are severe abdominal pain that develops in a few hours.

Diagnosis

The diagnosis of hypercholesterolemia, hypertriglyceridemia or of a hypoalphalipoproteinemia only be done with a blood test. The presence of cardiovascular disease or xanthomas in an individual but we suspect it will rarely diagnose, let alone, know the exact figures of cholesterol and triglycerides. The basic analysis is the determination of fasting total cholesterol, HDL cholesterol and triglycerides. If triglycerides are below 400 mg / dL, may be calculated LDL cholesterol through a simple mathematical formula. Where triglycerides, should investigate the presence of chylomicrons in the blood.

So we know if we serve the individual to have a disturbance of blood fats and what kind is this alteration.Also, the doctor will have a physical examination performed in search of xanthomas, corneal arcus and vascular murmurs. It also will make an inquiry about the family history of obesity, dyslipidemia, diabetes, hypertension, cardiovascular disease already present or presence of xanthomas, and staff questioning the same points, also including aspects such as menopause (in women) , smoking, alcohol intake, diet and exercise performance, and because the presence of cardiovascular disease.

From an academic standpoint, the analysis should be repeated to confirm the anomalies found and exploited to make any other determination as thyroid function and kidney and liver if they were not available.

Treatment

The main objective is to avoid the onset of cardiovascular disease and its complications. In some cases the objective is also the prevention of pancreatitis. To achieve this we must get a blood fat values ​​and that these numbers are maintained in a stable and sustained. But the figures which must be reached should not be based solely on the value of isolated cholesterol or triglycerides, but also in the presence of other risk factors, concomitant diseases such as diabetes, suffering from cardiovascular or renal disease, etc..

The correction of any disorder of cholesterol and triglycerides (regardless of the numerical values) goes through changes in dietary patterns and physical activity and smoking cessation, to which may be added drugs and other measures to the doctor deems appropriate.

Currently there are several effective and well tolerated drugs. The choice of drug must take into account individual characteristics. The main drugs used to treat abnormal cholesterol and triglyceride levels are statins, ezetimibe, resins, nicotinic acid, fibrates and omega 3 fatty acids. Many patients require multiple use of these medications for adequate control of fats.

Conclusions

Fats are a very important part of our life and our body incorporates food or manufactured by the liver.

The problem arises when our blood have more of these fats than we need and are deposited in the arteries and obstruct. The high numbers of fat we can only detect a blood test. And in these cases we must implement mechanisms to diminish and lessen the risk of cardiovascular disease and pancreatitis.