Elevated Lipoprotein - Primary Prevention and Management

Introduction:

Lipoproteins carry cholesterol and triglycerides to cells in the body. High lipoprotein levels increase the chances of having a heart attack, stroke, and aortic stenosis (narrowing of the blood vessel). Suppose the person has signs of hypercholesteremia (high cholesterol level); the risk of heart disease is higher. High cholesterol levels limit blood flow through the arteries (blood vessels). Lifestyle changes and medicines help reduce cholesterol.

What Are Lipoproteins?

The structure and functions of lipoproteins are-

• Lipoproteins are a core full of fat and cholesterol and a lipid membrane containing a protein called apo lipoproteins.

• When the triglycerides and cholesterol are removed from the lipoprotein complex, the protein alone that is left is referred to as an apo lipoprotein.

• A lipoprotein is a biochemical assembly that consists of lipids and proteins. Many enzymes, toxins antigens are lipoproteins.

• For the cholesterol and triglycerides to travel in the blood, they are carried by proteins that make the cholesterol and triglycerides more soluble in the blood.

• The cholesterol binds to the proteins and allows the fats to move through the water inside and outside cells. The proteins emulsify the lipid molecules.

• Lipoproteins are large macromolecular complexes that transport hydrophobic liquids, such as cholesterol and fat-soluble vitamins, through body fluids, such as plasma and interstitial fluids, to and from tissues.

• Lipoproteins play an essential role in the absorption of dietary cholesterol and fat-soluble vitamins from the liver to the peripheral tissues and transport cholesterol from the peripheral tissues to the liver.

• The function of LDL is to deliver cholesterol to the cells for synthesizing steroid hormones. Raised plasma levels of LDL have an increased risk for disease.

• Cholesterol travels through the blood on lipoproteins that are made of protein and fat.

What Are the Types of Lipoproteins?

The types of lipoproteins are as follows:

• High-Density Lipoprotein - The cholesterol is responsible for carrying the cholesterol back to the liver to be excreted out of the body. High levels of HDL reduce the risk of cardiovascular disease.

• Low-Density Lipoprotein - It is called bad cholesterol. It increases the risk of stroke, cardiovascular diseases, and heart attacks. LDL carries the cholesterol that accumulates in the blood vessels. Plaque buildup can make blood vessels too narrow.

• Very Low-Density Lipoproteins (VLDL) - This is bad cholesterol. It carries triglycerides and little cholesterol to the tissues.

• Intermediate-Density Lipoproteins - They are created as very low-density lipoproteins that give up their fatty acids. They are removed by the liver or converted into low-density lipoprotein.

• Chylomicrons - They are large particles that also transport triglycerides.

What Are Good and Bad Cholesterols?

The good and bad cholesterols are:

• Low-density cholesterol (LDL) is considered a bad lipid. High-density cholesterol (HDL) is considered a good lipid.

• Because low-density cholesterol is responsible for taking the cholesterol to the peripheral tissues, but HDL helps remove the cholesterol from the peripheral tissues and takes it back to the liver for processing.

• LDL deposits the cholesterol in the atheromatous plaque. The hepatocyte present in the liver has a receptor for LDL. This receptor can capture the LDL and take it in the hepatocytes.

• The liver clears about 40 to 60 percent of all low-density lipoproteins. A person with high LDL levels will have more supply of cholesterol to the injured endothelium. The atheromatous lesion will develop more rapidly.

• The rest are taken up by either hepatic (liver) LDL or non-hepatic LDL receptors.

• LDL (low-density cholesterol) builds up in the walls of the blood vessels.

• These cholesterol deposits decrease the blood flow to the heart, brain, kidneys, lungs, legs, and other body parts.

• It can cause increased clotting, leading to rapidly formed blockages in blood vessels.

• LDL promotes inflammation, increasing plaque rupture. Chronic inflammation leads to calcium buildup on the valve, causing stiffness. It will result in reduced blood flow. High-density lipoprotein can also lead to the narrowing of the aortic valve, called aortic stenosis, because of its role in inflammation.

What Is Hyperlipidemia, and What Causes Hyperlipidemia?

Hyperlipidemia refers to elevated levels of high cholesterol and fats in the blood. Hyperlipidemia is caused due to imbalance of cholesterol in the blood by a combination of LDL and HDL. The causes of hyperlipidemia include:

• Unbalanced diet.

• Insufficient exercise.

• Smoking.

• Obesity.

• Alcoholism.

• Diabetes.

• Kidney disease.

• Polycystic ovary syndrome (PCOS).

• Liver disease.

• An underactive thyroid.

• Familial combined hyperlipidemia (a type of hyperlipidemia that can inherit from parents that cause high cholesterol and triglyceride levels).

What Is the Primary Prevention for Elevated Lipoprotein?

The Non-pharmacological Methods of Managing Hyperlipidemia

Before deciding on the treatment, a random triglyceride, high-density lipoprotein level, and a complete triglyceride profile are checked. The patients are made to fast for 12 to 15 hours, and then the serum concentrations are measured. The patients are made to sit for five minutes before withdrawing the blood sample.

Pharmacological Methods of Managing Hyperlipidemia

• Lipid-lowering Therapy - Lipid-lowering agents such as Statins, Fibrates, bile acid binding agents, cholesterol absorption inhibitors, and nicotine acid and derivates.

• Statins - They are the primary and secondary choice of drugs to prevent cardiovascular diseases. The statins include Simvastatin (40 milligrams), Rosuvastatin, and Cerivastatin. The efficacy of statins has been demonstrated in several landmark, randomized, placebo-controlled trials. The statins bind and inhibit the enzyme HMG-CoA reductase. The inhibition of HMG-CoA reductase activity results in a drop in intracellular cholesterol production, thus activating the primary hepatic LDL receptors and increasing the clearance of LDL from the bloodstream. It results in total cholesterol, LDL, VLDL, and triglycerides with an increase in HDL. Statins have serious adverse effects on nursing infants. Women who require treatment should not breastfeed their children.

• Bile Acid Binding Agents - They regulate LDL receptors and enhance LDL clearance from the plasma. The adverse effects include constipation, heartburn, and bloating.

• Nicotinic Acid Derivates - Nicotinic acid derivates (NIACIN) have pharmacological doses of 1.5 to 6 grams. It can be used with a statin or for patients with statin intolerance.

• Niacin - Niacin is a water-soluble vitamin B that exerts a lipid-lowering effect by inhibiting the production of VLDL particles in the liver. Niacin is ideal for patients with elevated LDL and triglyceride levels and a normal or low HDL level. Niacin increases HDL levels by reducing its catabolism.

• Fibrates - Fibrates lower triglycerides by increasing the activity of lipoprotein lipase, the enzyme involved in hydrolysis triglycerides from VLDL and LDL particles.

Eating a Healthy Diet

Diet changes will lower the LDL cholesterol and increase HDL levels. A diet that includes fruits, vegetables, whole grains, potatoes, beans, legumes, nuts, seeds, heart-healthy fats, spices, and extra virgin olive oil should be consumed instead of saturated and trans fats. Olive oil is the primary source of fat and, in addition, low-fat, fat-free dairy products, cheese, yogurt, and eggs.

The diet should include more fish and poultry than red meat. Fatty fish are good in omega-3 fatty acids that help prevent inflammation. It focuses on plant-based foods and avoids processed food. Regular healthy food habits, including vegetables, fruits, and legumes, are very important for cardiovascular patients. Red wine should be included in moderate amounts with the main food. The diet limits or avoids refined sugars, sugary beverages, sodium, severely processed foods, refined carbohydrates, saturated fats, sugar in soda, candies, refined grains, refined oils, ice cream, white bread, pasta, and chips. Soda and sweet tea are very high in refined sugar. It avoids processed meat such as sausages and hot dogs. Water is considered the go-to beverage in the Mediterranean diet. Its diet includes poultry instead of red meat. This diet limits fried food and processed food that contains trans fats, which have no nutrition.

Lifestyle Changes

It can increase bad cholesterol levels and lower good cholesterol levels. Moderate aerobic exercises such as jogging, brisk walking, swimming, and cycling affect the lipid profile. Treatment is given to achieve blood pressure below 140 by 90 millimeters of mercury. Information on modifiable risk factors like physical fitness, alcohol intake, and smoking cessation. Even if hyperlipidemia is inherited, lifestyle changes are essential to the treatment.

The lifestyle factors that increase the chances of developing high cholesterol levels include:

• An unbalanced diet.

• No exercise.

• Smoking and continuous exposure to secondhand smoke.

• Obesity.

• Heavy alcohol use.

Conclusion:

High cholesterol causes serious health issues. People with untreated hyperlipidemia have double the risk of cardiovascular diseases. Eating a balanced diet, a nutrition-dense diet, and exercising regularly can help prevent this condition. When lifestyle changes cannot control the condition, it is better to consult a doctor and add medications such as statins to help bring cholesterol and triglycerides to normal levels. High cholesterol has no symptoms. To lower the risk of complications, healthy lifestyle habits are recommended.