What is Bad Cholesterol and Why is this Alarming - Health Education - DesiMD Healthcare - India
Health Education

What is Bad Cholesterol

Authored by DesiMD Doctor on 20 Mar 2013 - 11:16

I recently asked a patient of mine to get his blood cholesterol levels done. “Me?” he asked, “I am 42 years old and weigh just 60 kg. What could possibly be wrong with my blood cholesterol?”

The answer is – well – everything! A primary fact that people don’t take into consideration while thinking of hyperlipidemia (hyper – high & lipidemia – lipids in blood) is that it has a very low correlation with body weight. While it is true that obese people are more prone to have this condition it may equally affect thin and young people (Press, 2007). Hence if you were of the opinion that this article doesn’t concern you for another 10-15 years or 15-20 kgs, you’re wrong.

So let’s get to the basics.

What are lipids and what is hyperlipidemia?

Lipids are the stored energy of our body. They are comprised of triglycerides, cholesterol, and some vitamins. Apart from storage of energy they are key to homeostasis. Certain levels of lipids is necessary for the normal functioning of the body.

Lipids need to be transported to different parts of the body for metabolism as lipoproteins with the help of water soluble protien molecule:

  • The low density lipoproteins (LDL-C) (the BAD cholesterol)
  • Very low density lipoproteins (VLDL)
  • The high density lipoproteins (HDL-C) (the GOOD cholesterol)

Apart from this, fats are transported as chylomicrons and triglycerides. Almost all these lipids originate in the liver (except HDL and chylomicrons) and are transported to tissues.
Hyperlipidemia occurs when certain lipids in the blood are increased. This disrupts the ratio between two or more of such lipids and is the root cause of all further problems.

There are two basic forms of hyperlipidemia – primary and secondary.

  • Primary refers to genetically caused hyperlipidemia and will not be mentioned further.
  • The other, more common and preventable type is the secondary one. As the name suggests this condition is secondary to obesity, type 2 diabetes, drugs etc. (Longo, 2008).

Why is this alarming?

Hyperlipidemia can cause many medical problems and complications. These start with arteriosclerosis, insulin resistance, etc. and may lead up to devastating complications like diabetes, heart attack and stroke (Longo, 2008).

The best part of this is that it can be prevented, detected and treated at an early stage. It's important to note that while obese people aren’t the only ones who get hyperlipidemia they are certainly more prone to it. This is why obesity, measured by increased Body Mass Index (BMI) (Height in meters/ Weight in Kg2), is an excellent predictor of hyperlipidemia. People with BMI > 25 kg/m2 should get their cholesterol levels checked. Apart from this any person who has been diagnosed with hypertension, type 2 diabetes mellitus or thyroid diseases must also get their blood cholesterol tested.

Hyperlipidemia, which is detected by a fasting (at least 12 hours) blood lipid measurement, is characterized by elevated levels of LDL-Cholesterol and low levels of HDL-Cholesterol and an overall increase in the level of total cholesterol. The levels of triglycerides are also generally raised. LDL- C values should be lesser than 120 mg/dl although an optimal value as suggested by NCEP is 100 mg/dl. HDL-C values must be greater than 60 mg/dl while that of triglycerides must be lesser than 150 mg/dl.

Values that are typically alarming are:
LDL > 160 mg/dl, HDL < 40mg/dl for men and < 50 mg/dl for women, total cholesterol > 240 mg/dl and triglycerides > 160 mg/dl (NCEP, 2004)

The Treatment of Hyperlipidemia

The treatment of hyperlipidemia can be broadly divided into two main categories:
The first category consists of lifestyle modifications and weight reduction. By far this is the most effective form of therapy and will do wonders if properly followed. In fact this is the only form of therapy available in the initial stages.

Lifestyle modifications consist of dietary changes like:

  • Eliminating saturated fats from the oils that you use.
  • Switching to a refined oil which has more mono and poly unsaturated fatty acids along with low levels of cholesterol.
     
  • Starting a diet that is rich in vegetables, whole grains and fruits.
     
  • These have no cholesterol and contain lots of fibers. Flax seeds, cranberry juice, olive oil, avocados are some foods that specifically help raise HDL-C (the good cholesterol), hence try and incorporate these in your diet.
     
  • Avoiding tobacco smoke reduces the levels of cholesterol in blood and also reduces the chances of a heart attack (AHA, 2012).
     
  • Weight reduction by exercise will do great to reduce the levels of cholesterol. About 30 minutes of aerobic exercise will not only help reduce cholesterol but also de-stress you.
     
  • You can go for yoga or similar workout schedules with equal success. Just remember to consult your physician before embarking on any heavy exercises.

The second category for treatment is the use of drugs:

  • Drugs like statins, fibrates, nicotinic acid etc: Out of these statins are by far the most commonly used drugs for reduction of cholesterol levels. These drugs reduce the synthesis of LDL-C in the liver. Thus, they are highly effective in reducing the levels of LDL-C by almost 30-40%. Most of these drugs are to be taken at midnight because that’s when the production of cholesterol is at its maximum.
     
  • However, the effect of these drugs on raising HDL-C levels is by far modest. Thus additional therapy would be warranted if low HDL is the main problem. These drugs can lead to some amount of muscle soreness and muscle inflammation (myopathy) (Laurence L. Brunton, 2011).
     
  • The next category of drugs includes the fibrates (Gemfibrozil, Benzafibrate, Fenofibrate). These drugs primarily target the triglycerides in the blood. An additional advantage seen in this category of drugs is their reduction of clotting factors, thus reducing the probability of heart attack (Laurence L. Brunton, 2011).
     
  • Nicotinic acid (niacin) is another class uncommonly used in hyperlipidemia. The primary action of this is to raise HDL-C levels and it is probably the most effective drug for this purpose. However, the drug is poorly tolerated because it causes marked skin reaction including itching, flushing and hyperpigmentation. Further this drug cannot be used in people with diabetes or people predisposed to the same (Laurence L. Brunton, 2011).
     
  • Another uncommonly used class of drugs is the bile acid sequestrants. These drugs bind to the fats in the intestine and don’t allow them to get absorbed. The problem with this is the fats tend to cause bloating and flatulence. They also hinder the absorption of many other drugs and nutrients (Laurence L. Brunton, 2011).
     
  • A recently developed drug for the specific control of LDL-C is Ezetimibe. This drug specifically inhibits cholesterol absorption from the intestine. However, it is a weak drug if used alone. It is usually combined with statins or fibrates (Laurence L. Brunton, 2011).

In summary, the primary goal of treatment in hyperlipidemia should be lifestyle modifications and weight loss. Drug therapy should be used only when the levels of lipids are very high or certain additional risk factors like hypertension or diabetes is present.

The decision of which drug to use and the dose of the same must be highly individualized taking into account all the medical and non-medical factors present.

*Disclaimer
This is not a medical advice. The content is for educational purposes only, please contact your doctor for any health care issue.