Dyslipidemia

Original Editor - Rahma Ahmed Ahmed Bahbah

Top Contributors - Rahma Ahmed Ahmed Bahbah  

Introduction

Dyslipidemia is characterized by an elevation of low-density lipoprotein cholesterol (LDL-C) and reduced serum high-density lipoprotein cholesterol (HDL-C) concentration.

Reverse Cholesterol Transport

Reverse cholesterol transport (RCT) is a mechanism by HDL that works as the atheroprotective effect, means protects from atherosclerosis formation .

RCT is a net of reactions in which HDL release lipids from the subendothelial space and intima and deliver them to the liver. In contrast, apoB-containing lipoproteins (LDL, VLDL, IDL) promote atherosclerosis by driving cholesterol and phospholipids into the subendothelial space.

Hypoalphalipoproteinemia

Hypoalphalipoproteinemia is a term of low high-density lipoprotein cholesterol (HDL-C) level “good cholesterol". As a pathological condition, it may have two causes; primary and secondary to other sources.

Primary causes include the genetic deficit as in these conditions;

• Tangier disease,
• familial hypoalphalipoproteinemia,
• familial lecithin-cholesterol acyltransferase (LCAT) deficiency
• Familial combined hypolipidemia
• Elevated Cholesteryl ester transfer protein activity
• Lipoprotein lipase deficiency

Secondary causes of decreased HDL levels include:

• Severe sepsis
• Inflammatory conditions (such as systemic lupus erythematosus, rheumatoid arthritis, and Crohn disease)
• Monoclonal gammopathies
• Beta-blockers
• Benzodiazepines
• Exogenous testosterone replacement therapy

When treating patients with hypoalphalipoproteinemia, the objective is to reduce cardiovascular risk and increase HDL cholesterol levels.

Studies found that Statins play a role increase HDL-C levels by up to 15%. Statins have been found to exert an additional beneficial effect on cholesterol metabolism by reducing the transfer of triglycerides into HDL particles through cholesterol ester transfer protein (CETP). This mechanism leads to a reduction in the breakdown of HDL by hepatic lipase, ultimately resulting in increased levels of HDL cholesterol in the body. A study has shown that patients with average levels of triglycerides and LDL-C, coupled with below-average HDL-C, can experience substantial clinical benefits from the use of statins.

In addition of lifestyle changes turning it into healthy on by smoking cessation, keep an optimum weight, and healthy diet and exercise. The latter combination will improve plasma lipoprotein levels.

Lipid Disorders

There are different types of lipid disorders include;

• Dyslipidemia
• Hyperlipidemia
• Hypercholesterolemia
• Hypertriglyceridaemia
  

To know the difference, check this video

Atherogenic Dyslipidemia

Atherogenic Dyslipidemia (AD), also known as Diabetic dyslipidemia, comprises a triad of increased blood concentrations of small, dense low-density lipoprotein (LDL) particles, decreased high-density lipoprotein (HDL) particles, and increased triglycerides. AD is a typical feature of obesity, the metabolic syndrome, insulin resistance, and type 2 diabetes mellitus.

AD was associated with the presence of moderate-to-advanced liver fibrosis in type 2 diabetes mellitus with nonalcoholic fatty liver disease but not in non-diabetic subjects.

AD is associated with intracranial artery atherosclerosis and a high residual vascular risk after a stroke or transient ischemic attack. AD should be a promising modifiable target for secondary stroke prevention.

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Management

The primary treatment of dyslipidemia , as a lipid disorder, is a healthy lifestyle;

• an optimum weight,
• no smoking,
• exercising for 150 minutes per week, exercise may not lower LCL-C but aerobic exercise may improve insulin sensitivity, lower triglyceride levels and increase HDL.
• and a diet low in saturated and trans-fatty acids and enriched in fiber, fruit, and vegetables and fatty fish. Plant stanols at a dose of 2 g/d can help reduce LDL-C levels.

In recent decades, there has been growing interest in raising HDL cholesterol levels as a potential therapeutic approach for preventing and managing atherosclerotic cardiovascular disease (ASCVD). However, a closer examination of accumulating clinical data reveals that increasing HDL cholesterol levels does not demonstrate a significant positive impact on cardiovascular outcomes. In fact, there is evidence to suggest that it may even elevate the risk of non-cardiovascular diseases.

You can find here the most updated guidelines

• PEER simplified lipid guideline 2023 update, Prevention and management of cardiovascular disease in primary care
• Updated guidelines for the management of dyslipidemia and the prevention of cardiovascular disease in adults by pharmacists