Symptoms, Types, and Diagnosis of Dyslipidemia | Cardiology


What is dyslipidemia?

Dyslipidemia is an abnormal amount of lipids (for example, triglycerides, cholesterol, and/or fatty phospholipids) in the blood. In developed countries, most dyslipidemias are hyperlipidemias. That is to say, an elevation of the lipids in the blood. This is often due to diet and lifestyle. Prolonged elevation of insulin levels can also cause dyslipidemia. Also, elevated levels of O-GlcNAc transferase (OGT) can cause dyslipidemia.

Symptoms of dyslipidemia

Unless it’s severe, most people with dyslipidemia don’t know they have it. A doctor will usually diagnose dyslipidemia during a routine blood test or a test for another condition.

Untreated or severe dyslipidemia can lead to other conditions, such as coronary artery disease (CAD) and peripheral artery disease (PAD).

Both CAD and PAD can cause serious health complications, including heart attacks and strokes. Common symptoms of these conditions include:

  • Pain in the legs, particularly when walking or standing
  • Chest pain
  • Tightness or pressure in the chest and shortness of breath
  • Pain, tightness, and pressure in the neck, jaw, shoulders, and back
  • Indigestion and heartburn
  • Trouble sleeping and exhaustion during the day
  • Dizziness
  • Heart palpitations
  • Cold sweats
  • Vomiting and nausea
  • Swelling in the legs, ankles, feet, stomach, and neck veins
  • Fainting

These symptoms can get worse with activity or stress and improve when the person rests. Anyone experiencing severe chest pain, dizziness, and fainting, or trouble breathing should seek emergency care.

Types of dyslipidemia

Dyslipidemia is divided into primary and secondary types. Primary dyslipidemia is inherited. Secondary dyslipidemia is an acquired condition. That means it develops from other causes, such as obesity or diabetes.

You may hear the period hyperlipidemia used interchangeably with dyslipidemia. But that is not entirely accurate. Hyperlipidemia mentions high levels of LDL or triglycerides. Dyslipidemia can refer to levels that are higher or lower than the normal range for those fats in the blood.

Specific types of primary dyslipidemia include:

Combined familial hyperlipidemia: This is the most common inherited cause of high LDL cholesterol and high triglycerides. If you have familial combined hyperlipidemia, you could develop these problems in your teens or early 20s. You are also at increased risk for early coronary artery disease, which can lead to a heart attack. Learn more about this condition.

Familial hypercholesterolemia and polygenic hypercholesterolemia: Both are characterized by high total cholesterol. You can calculate your total cholesterol by adding your LDL and HDL levels, along with half your triglyceride level. The best is a total cholesterol level of fewer than 200 milligrams per deciliter (mg / dL).

Familial hyperapobetalipoproteinemia: This disorder means that you have high levels of apolipoprotein B, a protein that is part of your LDL cholesterol.

Hyperlipoproteinemia: It is a condition that can be primary or secondary. If you have this condition, your body has a hard time breaking down LDL cholesterol or triglycerides.

Causes of dyslipidemia

There are many factors that can cause dyslipidemia, from inherited disorders to your lifestyle. The causes of dyslipidemia can be alienated into two main categories: primary or secondary dyslipidemia.

Primary dyslipidemia: Primary dyslipidemia refers to abnormal lipid levels caused by a mutated gene or genes inherited from one or both parents. Defective genes can cause abnormal lipid clearance or can change the way certain lipids are made in the body. Body. If dyslipidemia is inherited, the condition will often have the term “familial” in its name to indicate that it is a hereditary condition. People with primary dyslipidemias that involve an increase in LDL are at high risk of developing atherosclerosis early in life, which can lead to premature cardiovascular disease.

Secondary dyslipidemia: Secondary dyslipidemia, on the other hand, is more common and occurs due to a variety of factors involving certain aspects of your lifestyle or certain medical conditions you may have. Secondary hyperlipidemias can be caused by primary dyslipidemia

  • Diet poor or high in fat and sugar
  • Lack of exercise
  • Certain medications such as beta-blockers, certain medications to treat HIV, and oral contraceptives
  • Liver disease
  • Alcohol abuse
  • Smoking cigarettes
  • Hypothyroidism that has not been treated
  • Uncontrolled diabetes

Subordinate hypolipidemias, which are less shared, can be caused by untreated hyperthyroidism or certain cancers.

Risk factors of dyslipidemia

Several factors are known to raise the chances of developing dyslipidemia and related conditions. These risk factors include:

  • Obesity
  • A sedentary lifestyle
  • Lack of regular physical exercise
  • Alcohol consumption
  • Tobacco use
  • Use of illegal or illicit drugs
  • Sexually transmitted infections
  • Type 2 diabetes
  • Hypothyroidism
  • Chronic kidney or liver conditions
  • Digestive conditions
  • Older
  • A diet rich in soaking and trans fats
  • Apparent or grandparent with dyslipidemia
  • Female sex, as women tend to experience higher levels of LDL after menopause

Diagnosis of dyslipidemia

Serum lipid profile (unrushed total cholesterol, TG and HDL cholesterol, and intended LDL cholesterol and VLDL cholesterol). Dyslipidemia is supposed in patients with characteristic physical findings or complications of dyslipidemia (eg, atherosclerotic disease).

Primary lipid disorders are suspected when patients have:

  • Physical signs of dyslipidemia
  • The onset of premature atherosclerotic disease (<60 years)
  • Family history of atherosclerotic disease.
  • Serum cholesterol> 240 mg / dL (> 6.2 mmol / L)
  • Lipid panel icon

Dyslipidemia is diagnosed by measuring serum lipids. Routine measurements (lipid profile) include total cholesterol (TC), TG, HDL cholesterol, and LDL cholesterol.

Lipid profile measurement

Total cholesterol, triglycerides, and HDL cholesterol are measured directly. TC and TG values reflect cholesterol and TGs in all circulating lipoproteins, including chylomicrons, VLDL, intermediate-density lipoproteins (IDL), LDL, and HDL. CT values can vary by 10% and TG values by up to 25% from day to day even in the absence of a disorder. TC and HDL cholesterol can be measured in the non-fasting state, but most patients should have all lipids measured in the fasting state (usually for 12 hours) for maximum accuracy and consistency.

Pearls and traps

Total cholesterol and HDL can be measured without fasting, but most patients should have all lipids measured fasting (usually for 12 hours) for maximum accuracy and consistency.

Testing should be postponed until after resolution of the acute disease because TG and lipoprotein (a) levels increase and cholesterol levels decrease in inflammatory states. Lipid profiles can vary for approximately 30 days after an acute myocardial infarction (MI); however, results obtained within 24 hours of myocardial infarction are usually reliable enough to guide initial lipid-lowering therapy.

LDL cholesterol values are most often calculated as the amount of cholesterol not contained in HDL and VLDL. VLDL is estimated by TG ÷ 5 because the concentration of cholesterol in VLDL particles is usually one-fifth of the total lipid of the particle.

This calculation is valid only when TGs are <400 mg / dL (<4.5 mmol / L) and patients are fasting because eating increases TG. The calculated LDL cholesterol value incorporates measurements of all non-HDL cholesterol, without chylomicrons, including that of IDL and lipoprotein (a) [Lp (a)].


LDL cholesterol icon

LDL can also be measured directly by plasma ultracentrifugation, which separates chylomicrons and VLDL fractions from HDL and LDL, and by an immunoassay method. The direct measurement may be helpful in some patients with elevated TG, but these direct measurements are not routinely necessary.

The role of the apo B test is under study because the values ​​reflect all non-HDL cholesterol (in VLDL, traces of VLDL, IDL, and LDL) and maybe more predictive of CAD risk than LDL cholesterol. Non-HDL cholesterol (TC – HDL cholesterol) may also be more predictive of coronary heart disease risk than LDL cholesterol, especially in patients with hypertriglyceridemia.


Very low-density lipoprotein (VLDL) icon

Other tests

Patients with premature atherosclerotic cardiovascular disease, cardiovascular disease with normal or near-normal lipid levels, or high LDL levels refractory to drug therapy should measure Lp (a) levels. Lp (a) levels can also be measured directly in patients with borderline high LDL cholesterol levels to determine whether drug therapy is warranted.

Measurements of the number of LDL particles or apoprotein B-100 (apo B) may be useful in patients with elevated TG and metabolic syndrome. Apo B provides similar information on the number of LDL particles because there is one apo B molecule for each LDL particle. The Apo B measurement includes all atherogenic particles, including debris and Lp (a).

Treatment for dyslipidemia

A doctor will generally focus on lowering a person’s triglyceride and LDL levels. However, treatment can vary, depending on the underlying cause of dyslipidemia and its severity. Doctors may suggest one or more lipid-modifying medications for people with very high total cholesterol levels of at least 200 milligrams per deciliter of blood.

High cholesterol is typically treated with statins, which interfere with the production of cholesterol in the liver. If statins fail to lower LDL and triglyceride levels, a physician may recommend additional medications, including:

  • Ezetimibe
  • Niacin
  • Fibrates
  • Bile acid sequestrants
  • Evolocumab and alirocumab
  • Lomitapida and mipomersen
  • Some lifestyle changes and supplements can help support healthy blood lipid levels.

Natural treatments include:

  • Cutting back on unhealthy fats, such as those found in red meat, whole dairy products, refined carbohydrates, chocolate, chips, and fried foods
  • Exercise regularly
  • Maintain a fit body weight, losing weight is essential
  • Reduce or avoid alcohol consumption
  • Quitting smoking and extra use of tobacco products
  • Avoiding sitting for long periods of time
  • Increase your intake of healthy polyunsaturated fats, such as those found in nuts, seeds, legumes, fish, whole grains, and olive oil
  • Taking omega-3 oil, either in liquid or capsule form
  • Eat plenty of dietary fiber from fruits, vegetables, and whole grains
  • Sleep at minimum 6 to 8 hours a night
  • Drinking a lot of water

Prevention of dyslipidemia

Try to maintain a healthy weight by eating a heart-healthy diet and exercising regularly. You should also stop smoking if you smoke. If you are concerned about dyslipidemia, talk to your doctor about how to protect yourself against it.

If you have a family history of high cholesterol, be proactive in living a healthy life before your cholesterol numbers start to move toward unhealthy levels.

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