Hyperlipidemias - Primary.html

About Your Diagnosis
Hyperlipoproteinemia is high lipoprotein levels in the blood. A high blood lipoprotein level is one of the risk factors for atherosclerosis (hardening of the arteries) and heart disease. Heart disease from atherosclerosis and coronary artery disease is the leading cause of death in the United States. Cholesterol is a lipid, a type of fat. It performs many normal functions in the body. Cholesterol is made in the liver for involvement in the formation of hormones. It is part of the cell structure. It transports fats in the blood stream. Cholesterol is part of fat-protein structures in the blood called lipoproteins. Lipoproteins are classified on the basis of their density from very low-density lipoproteins (VLDLs) to low-density lipoproteins (LDLs) to high-density lipoproteins (HDLs). The more cholesterol in the lipoprotein, the denser is the cell. VLDLs are mostly fat and can clog the arteries. Denser lipoproteins, the HDLs, can help remove fats (lipids) from the bloodstream. That is why HDLs are considered the good cholesterol. The desirable level of LDL is less than 130 mg/ dl. Borderline high levels are 130 to 159 mg/dl. High levels are 160 mg/dl or higher. Desirable levels of HDL are greater than 35 mg/dl; A level greater than 45 mg/dl may help protect from cardiovascular disease.
Living With Your Diagnosis
You cannot feel high cholesterol in your blood. Some genetic conditions can cause high or low cholesterol and high or low levels of HDLs. Primary hyperlipoproteinemia is a genetically inherited disorder of metabolism of fats that causes high blood lipoprotein levels. Secondary disorders are associated with a disease or condition that causes the disorder. Persons with this genetic predisposition to high blood lipoproteins are at increased risk for early heart disease and stroke. Women tend to have higher HDL levels than men because of the influence of the female hormone estrogen. HDL levels can be increased with endurance exercise, low body fat (leanness), moderate amounts of alcohol (particularly those with high flavinoids such as red wine), and insulin and lipidlowering drugs. HDL levels are decreased with male hormones, menopause (lack of the female hormone estrogen), obesity, sedentary lifestyle, high triglyceride levels, diabetes, and cigarette smoking. Cholesterol levels are determined by means of analysis of blood samples. Specific types of lipoproteins can be calculated with these blood tests. Most persons with high blood lipoprotein or cholesterol have no symptoms. The fats deposited in the blood vessels do not produce symptoms until the vessels are nearly closed or become clogged. Some patients with hyperlipoproteinemia have pancreatitis (inflammation of the pancreas) or xanthomas, which are small fatty deposits under the skin. Because it is produced in the body by the liver, cholesterol does not have to be consumed. The best way to lower lipoprotein and cholesterol levels is to decrease fat and cholesterol intake and to promote lipoprotein removal by raising HDLs. Diseases such as diabetes must be carefully monitored and managed.
Treatment
Lipid-lowering drugs may be used to treat persons who are unsuccessful at reducing blood lipoprotein and cholesterol levels. Continuation of the measures described earlier is important even after starting lipid-lowering medicines. The main classes of medicines for management of hyperlipoproteinemia and hypercholesterolemia include: bile acid–binding resins, nicotinic acid, statins (HMG CoA reductase inhibitors), and fibric acid (gemfibrozil). Bile acid–binding resins are the primary treatment of most patients who need drugs; they include cholestyramine and colestipol. These agents increase the passage of cholesterol into the intestines for removal through the colon (large bowel). Nicotinic acid (niacin) helps lower VLDL and increase HDL. The statins (lovastatin, pravastatin, simvastatin) decreases production of cholesterol and LDL. Gemfibrozil helps increase removal of VLDL. The medicines can have an unpleasant taste and can cause nausea, abdominal pain, and diarrhea or constipation. Niacin can cause facial flushing and itching. It cannot be used by persons with liver disease, diabetes, or gout.
The DOs
•Eat a diet low in cholesterol and saturated fats.
•Eat fruits and vegetables and high-fiber foods such as oat bran.
•Cook with oils high in polyunsaturated fats such as safflower oil, sunflower oil, and corn oil (omega-6 fatty acids).
•Eating fish, because the fish oils contain omega-3 fatty acids that may help lower cholesterol.
•Stop smoking.
•Lose weight to lower body fat. This is best accomplished with dietary changes (reducing calories and fat) and performing regular aerobic exercise such as walking, jogging, bicycling, or swimming.
•Exercise. The aerobic exercises should be done for at least 30 minutes a day at least 3 or 4 days per week. Exercise helps lower your body weight and body fat, helps control your blood pressure, helps most persons with diabetes control the disease, and strengthens the heart.
•Discuss estrogen replacement therapy with your physician. Postmenopausal women can obtain cardiac protective benefits from hormone replacement (if they do not smoke and have no history of clotting disorders or breast or gynecological cancers).
•Consume moderate amounts of alcohol (usually a glass or two of red wine a day). Not everyone should consume alcohol. Discuss this with your physician.
The DON’Ts
•Do not forget to take your medications as directed.
When to Call Your Doctor
•If you have hyperlipoproteinemia, have regular follow-up visits with your doctor to monitor your blood lipoprotein and cholesterol and heart disease. Discuss the progress of your diet and exercise and any side effects of medications.