Hyperlipidemia

definition

The term Hyperlipidemia is made up of "hyper" (too much, excessive), "lipid" (fat) and "-emia" (in the blood) and describes a Excess of fats in the blood. In common usage, the term "High blood lipids" used.
In the blood are found different fats: Neutral fats, cholesterol and Lipoproteins. Lipoproteins are protein particles that transport fats in the blood. There are various subgroups of them.

causes

A Hyperlipidemia is actually a symptom an underlying medical condition or symptom of a Metabolic overload. The metabolism can go through poor diet (too many calories, too high fat) and one unfavorable lifestyle be overloaded without sufficient exercise. For example, the level of neutral fats in the blood is already falling unique athletic movement from. The level of neutral fats is largely determined by the diet. Of the Cholesterol levels in the blood, on the other hand, is to mostly hereditary conditional and can only be influenced to a lesser extent by diet.
Hyperlipidemia is a common symptom of the metabolic syndrome, to that too Obesity, impaired glucose tolerance or insulin resistance or Diabetes mellitus and high blood pressure belong. In metabolic syndrome they are Neutral fats and the LDL cholesterol increases, the good" HDL cholesterol but humiliated. Hyperlipidemia during pregnancy is completely normal due to the change in metabolism to a certain extent.

Find out more about the topic here: Lipid metabolism disorder

Other causes of hyperlipidemia are high Alcohol consumption, chronic Liver and kidney disease or one Hypothyroidism. Taking various Medication can also cause hyperlipidemia. This includes Cortisone preparations, Beta blockers, the Birth control pills and Hormone replacement preparations in postmenapausal women.
A person's blood lipid levels increase with age. Here is that Higher risk for men than for women: the age-related rise in cholesterol levels (especially “bad” LDL cholesterol) occurs more quickly in them. In addition, due to genetic factors, they have a lower level of the “good” HDL cholesterol.

In addition to these forms of illness, diet or lifestyle triggered Hyperlipidemia there is still a wide range of hereditary hyperlipidemia. This is what happens with the familial Hypercholesterolemia through an inherited Genetic damage cause fewer or no LDL receptors to form on cells, causing the LDL to build up in the blood. In most cases this disease is inherited through various genes, affecting around 0.2% of the population. Inheritance through just one gene is also possible. This affects about one person in a million.

Symptoms

The blood lipids are in “Good” and “bad” fats assigned. The HDL cholesterol is the "good" cholesterol. The most important representative of the "bad" fats is that LDL cholesterol. Like all other "bad" fats, it increases the risk of one Atherosclerosis (Hardening of the arteries). The hardening of the arteries unfortunately remains symptom-free for a very long time. Secondary diseases only occur when the arteries are extremely calcified. The hyperlipidemia therefore often persists for a long time undetected.
Disorders caused by hyperlipidemia include all diseases caused by hardening of the arteries. At heart that's the one CHD (Coronary heart desease). The KHK affects the Coronary arteries and leads to a poor oxygen supply to the heart musclethat are in Angina attacks expresses. Of the Heart attack is another consequence of coronary heart disease.

Another possible consequence of hardening of the arteries is stroke (Apoplexy). On the legs the hardening of the arteries manifests itself as PAOD (Peripheral arterial disease). The PAOD causes Circulatory disorders of the legs and is noticeable by pain when walking.
In the case of pronounced hyperlipidemia, a Inflammation of the pancreas arise. The excess fats can build up in the liver, one Fatty liver arises. Less common symptoms are deposits of the Cholesterol in tendons and skinwhat as Xanthoma referred to as. Deposits on the eyelids are called xanthelasma, deposits in the eye are called "Arcus lipoides cornea". These deposits can, however, also occur in patients with normal blood lipid levels and are not an absolutely conclusive symptom of hyperlipidemia.

therapy

Therapy goal at Hyperlipidemia is the Decrease in blood lipid levels. The neutral fats should reach values ​​below 150 mg / dl (1.7mmol / l), the LDL cholesterol, depending on the risk profile of the patient, below 70 mg / dl (1.8mmol / l) or below 115 mg / dl (3mmol / l) ) amount.
The "Good" HDL cholesterol should be over 40mg / dl for men and over 50mg / dl for women. HDL is for the Return of the cholesterol to the liver responsible and therefore lowers that Atherosclerosis risk.
The first measure to lower blood lipid levels is a healthy one nutrition and a healthy lifestyle. Patients should eat a balanced diet, avoid the high-calorie and high-fat fast foods that Smoke give up and up sufficient exercise respect, think highly of. Even 30 minutes of exercise a day lower the neutral fats and the "bad" LDL and increase the "good" HDL. An adapted Diet for fatty liver can make this symptom of elevated blood lipids go away.
The ingested dietary fat should be accompanied by an appropriate Nutritional therapy be reduced to less than 30% of total calories and switched from animal to vegetable fats. Eating fish regularly has a positive effect on you because of the good omega-3 fatty acids Hyperlipidemia out.
Patients should complex carbohydrates (Whole grain) and a lot protein eat a lot of fruits and vegetables. In the case of high cholesterol levels, attention should be paid to the intake of cholesterol with food, which should not exceed 300 mg per day. For example, an egg yolk already contains around 270 mg of cholesterol.
At increased neutral fats In addition to the general nutritional tips, alcohol abstinence and switching to 5 smaller meals Recommended daily (instead of three). A healthy diet lowers cholesterol levels by 20-60 mg / dl. It also improves the response to medication.
In addition, triggering factors should be the Hyperlipidemia be eliminated: a Diabetes mellitus should be well adjusted and one Hypothyroidism be treated. Obese patients should lose weight. In addition, patients should refrain from alcohol. More risk factors like one too high blood pressure should be treated with medication if necessary.
Can through a conscious diet insufficient depression If the blood lipid levels are achieved, drugs can be used to treat hyperlipidemia. The most effective cholesterol lowering drugs on the market are those Statins. They inhibit the key enzyme in cholesterol synthesis, HMG-CoA reductase. As a result, less cholesterol is produced in the cells and the cells take in more cholesterol from the bloodstream. Statins lower the risk of all atherosclerosis-related diseases (e.g. heart attack, stroke). However, the responsiveness to statins can be very different in different patients. Statins, however, interact with many other drugs (e.g. verapamil) and can be a side effect Muscle pain or weakness trigger. In rare cases, life-threatening rhabdomyolysis (dissolution of muscle fibers) can occur.

Other drugs used in therapy Hyperlipidemia are the Bile acid binder colestyraminewhich can be combined with these if the statin effect is insufficient. Other drugs are Ezetimibe (inhibits cholesterol absorption) and Fibrates (must not be combined with statins).

A newer method, which can be used in addition to drug therapy in severe hyperlipidemia, is the Lipid apheresiswhich is done once a week. Here are the excess blood lipids from the blood filtered out.

diagnosis

Diagnosing a Hyperlipidemia is through a Blood collection posed. Patients should be given blood samples before blood collection 12 hours sober in order not to falsify the blood lipid values ​​through ingested food. Screening is carried out by the family doctor from the age of 35. The screening includes determining the Total cholesterol and des HDL cholesterol. Regular screening is also required Patients with risk factors for atherosclerosis carried out, for example at Diabetics.

The survey of a complete lipid status goes beyond the normal screening: In addition to HDL cholesterol and total cholesterol, the neutral fats in the blood are also determined. From these values, the Amount of LDL cholesterol be calculated. Then the quotient total cholesterol / HDL cholesterol is calculated: values under 4 speak for a low risk of atherosclerosis, Values ​​between 4 and 4.5 are within the normal range. With values over 4.5 an increased risk of atherosclerosis can be assumed.
From one Hypertriglyceridemia (Increase in neutral fats in the blood) one speaks at values ​​above 150mg / dl (1.7mmol / l). The Hypercholesterolemia (elevated cholesterol levels) is defined by cholesterol levels above 200mg / dl (5.2mmol / l).
Would you like more about that Hyperlipidemia of the patient can find out a Electrophoresis (Investigation of the Blood in an electric field). The different fats in the blood are divided up. If one is suspected hereditary hyperlipidemia can genetic studies be performed.

Types

Hyperlipidemias are classified either clinically or by Frederickson's electrophoresis.
The clinical classification is based on the type of fat increased. One distinguishes the Hypercholesterolemia, the Hypertriglyceridemia and combined hyperlipidemias as well as lipoprotein disorders.
The Classification according to Frederickson is based on the lipoproteins involved (protein particles that transport fats in the blood), which can be identified by electrophoresis. The Lipoproteins differ in theirs composition and in their function of neutral fats and cholesterol. Be after Frederickson 5 types (Type I, Type IIA, Type IIB, Type III and Type IV) differentiated:

• Type I: The Frederickson Type I has one significant increase in neutral fats in the blood, in addition, the chylomicrons are increased. Chylomicrons transport the fat ingested with food from the intestine via the lymph into the bloodstream. Here the neutral fats are broken down and then absorbed in fat and muscle cells. Frederickson's Type I is very rare.
• Type IIA: With type IIA, they are Total cholesterol increased. They are mainly involved here LDL lipoproteins. LDL lipoproteins carry cholesterol from the liver to the rest of the body, where they are taken up into cells through LDL receptors. The cholesterol is built into cell walls and serves as the basis for Bile acid or Steroid hormones. Elevated LDL lipoproteins represent a significant Risk factor for atherosclerosis represent.About 10% of all patients with hyperlipidemia have Frederickson type IIA.
• Type IIB: With type IIB, in addition to Total cholesterol also includes the neutral fats elevated. The lipoproteins involved are the LDL lipoprotein (mainly transports cholesterol) and the VLDL lipoprotein. The VLDL lipoprotein mainly transports neutral fats produced in the liver from the liver to the fat and muscle cells of the body. Elevations in VLDL (just like the LDL elevation) set one Risk factor for atherosclerosis The Frederickson type IIB comprises around 15% of all hyperlipidemias.
• Type III: Type III describes an increase in total cholesterol and neutral fats. The lipoproteins involved are so-called VLDL remnants or IDL lipoproteins. They are breakdown products of the VLDL lipoproteins and, if they are increased, they are also a risk factor for atherosclerosis. About 5% of patients with hyperlipidemia have Frederickson Type III.
• Type IV: This guy is coming with me 70% most often. In type IV, the neutral fats are increased; the VLDL lipoproteins (mainly transport neutral fats), which are a risk factor for atherosclerosis, are involved.

ICD classification system

Of the ICD-10, the currently valid diagnosis classification system of the WHO classifies the various forms of hyperlipidemia according to the increased components. Different codes summarize different clinical pictures in one diagnosis: E78.0 describes a pure one High cholesterol, E78.1 a pure Hypertriglyceridemia (Increase in neutral fats). E78.2 describes mixed forms, E78.3 one Increase in chylomicrons. Chylomicrons consist mainly of neutral fats and transport the fats ingested with food from the intestine via the lymph into the bloodstream. E78.4 and E78.5 describe a different one or an unspecified one Hyperlipidemia. E78.6 describes deficiencies in various lipoproteins, E78.8 and E78.9 describe another or an unspecified disorder of lipoprotein metabolism.