A Practical Guide To Management of Hyperlipidaemia

Back | 1 | 2

Hyperlipidaemia is a condition characterised by increased concentrations of lipids (triglycerides, cholesterol) and lipoproteins [low density lipoproteins (LDL) and very low density lipoproteins (VLDL)] in the blood.

• Hypercholesterolaemia: Increased cholesterol levels
• Hypertriglyceridaemia: Increased triglyceride levels
• Mixed hyperlipidaemia: Increased cholesterol and triglyceride levels

• Primary hyperlipidaemia: This occurs as a result of a genetic defect.
• Secondary hyperlipidaemia: This occurs as a result of another illness or metabolic disturbance e.g. diabetes mellitus.

• Age (males > 45 years, females > 55 years)
• Heredity
• Sedentary life style
• Diet rich in saturated fats and cholesterol
• Associated medical conditions e.g. diabetes mellitus, nephrotic syndrome, hypothyroidism, alcoholism, obstructive liver disease, etc.

• Hyperlipidaemia is a major risk factor for atherosclerosis. Atherosclerosis is the underlying disorder in a vast majority of cases of coronary heart disease (angina, myocardial infarction). It is also a major risk factor for stroke.

Figure : Process of atherosclerosis

• Low density lipoprotein (LDL) is pro-atherogenic. Hence high levels of LDL increase coronary heart disease (CHD) risk.
• High density lipoprotein (HDL) is anti-atherogenic. Hence low levels of HDL increase CHD risk.

Every 1% increase in cholesterol leads to a 2% increase in CHD risk.

• Serum cholesterol estimation
  The United States National Cholesterol Education Program (NCEP) guidelines state that serum total cholesterol and HDL-cholesterol should be measured in all adults 20 years of age and over, at least once every 5 years.
  
  In individuals who do not have CHD (no previous history of angina, myocardial infarction), the total cholesterol and HDL-cholesterol should be first measured. Then depending on the values and the risk factors for CHD present in that particular patient, LDL-cholesterol should be measured.

• Lipoprotein analysis (for estimation of LDL cholesterol)
  This includes measurement of fasting (12-14 hours) levels of total cholesterol, total triglycerides and HDL-cholesterol. From these values, the LDL-cholesterol value is estimated.

  Lipoprotein analysis is required for the following patients:

• Person with blood cholesterol <200 mg/dl and HDL-cholesterol < 35 mg/dl
• Person with total cholesterol levels of 200 to 239 mg/dl who have an HDL- cholesterol less than 35 mg/dl or two or more risk factors for CHD
• Person whose total cholesterol is 240 mg/dl or greater
• All patients of CHD

  Alternatively, a lipoprotein analysis may be performed for all patients.
  

• Age : Male >45 years
           Female > 55 years or premature menopause without estrogen replacement          therapy
• Family history of premature CHD
• Smoking
• Hypertension
• HDL-cholesterol <35 mg/dl
• Diabetes

• HDL-cholesterol >60 mg/dl

The decision to treat hyperlipidaemia with dietary therapy or drugs is based on the LDL-cholesterol value. The aim is to achieve the appropriate LDL goal.