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I would like to simplify the big words we use while discussing with our patients things they may or may not understand like LDL, VLDL, HDL, triglycerides, atherosclerosis, and plaque.
Fat from food (both saturated and trans fat) enters the stomach and with the help of enzymes from the stomach, liver, and pancreas gets emulsified and absorbed. After absorption from the intestines, lipids enter the bloodstream. Since lipids (fat) are insoluble in blood, it is carried with the help of protein. Protein, being a carrier, gives lipids a different name (lipid +protien), lipoprotien, which signifies the ratio of protein to lipid (fat).
1. LDL = PROTEIN + LIPIDS is high fat content with low protein
As you may already know, LDL cholesterol is often called bad cholesterol because it can build up in the walls of our arteries and form plaque, which can narrow and reduce the blood flow and the oxygen it carries to the heart and other parts of the body that would result in angina, heart attack, stroke, and peripheral arterial disease, which can lead to death.
2. VLDL = PROTEIN + LIPIDS is also bad cholesterol with very high fat content and low protein
3. HDL = HIGH PROTIEN + LOW FAT (GOOD CHOLESTEROL) HDL is called a good cholesterol
It has high amount of protein with low cholesterol. HDL picks up and carries the cholesterol to places where it is needed.
TRIGLYCERIDES are lipids (fat) transferred and deposited in adipose tissue like abdominal fat. Pot belly and an increase in waist size are indicative of impending heart disease, and even pancreatitis
Cholesterol is produced by many organs in the body with major contributions from the liver and diet. Both dietary cholesterol, and that synthesized, are transported through the circulation as lipoprotein particles.
Atherosclerosis (plaque) is made up of fat, cholesterol, and calcium found in the blood that hardens our arteries and narrows over time. It starts as early as 16 years of age.
Hyperlipidemia may be either genetic, acquired, or it may be idiopathic, that is without a known cause. It is common in the general population.
Diagnostic tests needed for hyperlipidemia:
- Lipid profile
- Fasting glucose
- Liver enzymes
- Apolipoprotein and c-reactive protein are markers for inflammation leading to coronary artery disease
- Thyroid-stimulating hormone (TSH)
- Urinary protein
- Coronary calcium scans, also called cardiac calcium scoring
Calcium in the coronary arteries may be a sign of coronary artery disease, leading to heart disease.
Management of hyperlipidemia
Dietary modification is the initial approach, then lifestyle modifications (exercise) on regular bases 4 to 5 times a week/15 minutes. Many patients require treatment with medication to reduce cardiovascular risk. Combination treatment of low cholesterol diet and cholesterol lowering medication are highly effective. Other agents commonly added to OTC medicine are niacin and fish oil tablets. Omega-3 fatty acids reduce the triglycerides level.