What Are Lipid Disorders?
Dyslipidemia, often known as lipid disease, describes abnormal blood levels of fats and/or cholesterol. High-density lipoprotein (HDL-C referred to as good cholesterol) and low-density lipoprotein (LDL-C referred to as bad cholesterol) are two separate forms of cholesterol. Having high LDL-C levels is typically referred to as having high cholesterol.
The blood also contains a component called "bad" fat called triglycerides. High LDL-C, low HDL-C, and high triglyceride values are typical lipid diseases. Lipid problems raise the risk of atherosclerosis, or more broadly, cardiovascular disease, which is characterized by plaque buildup inside blood vessels. Heart attacks and strokes can result from atherosclerosis in the blood arteries of the heart or brain.
Why Is Screening for Lipid Disorders Important?
Evidence suggests that one of the main risk factors for coronary heart disease (CHD) is having high levels of total cholesterol, reduced lipoprotein (LDL) lipids, and low levels of high-density lipid (HDL) cholesterol. Individuals with a multitude of risk factors are most at risk for CHD. Even in aberrant lipid levels, the 10-year chance of heart disease is the least in young men and women with no other risk factors. The USPSTF (U.S. Preventive Services Task Force) discovered strong support for the idea that lipid testing can detect undiagnosed men and women who qualify for preventive treatment.
What Are the Benefits of Screening for Lipid Disorders?
In people with aberrant cholesterol levels, there is strong evidence that lipid-lowering medication therapy significantly lowers the incidence of chronic heart disease (CHD). Lipid-lowering treatment may or may not provide absolute advantages depending on a person's underlying risk for CHD.
The course of treatment will significantly improve the situation of men and women who are at increased risk for chronic heart disease (CHD) and are older than 35 and 45, respectively. Younger persons who have dyslipidemia and other CHD risk factors will have a modest benefit from therapy. Evidence suggests a risk decrease of 10-year chronic heart disease (CHD) event rate in younger men and women. Individuals without CHD risk factors will experience minimal benefit from treatment.
What Are the Disadvantages of Screening for Lipid Disorders?
There is strong evidence that screening and treatment have few adverse effects, including potential labeling and side effects from lipid-lowering medication (for example, rhabdomyolysis).
What Are the Clinical Considerations for Screening of Lipid Disorders?
Elevated levels of total cholesterol, LDL cholesterol, or triglycerides, as well as a deficiency in HDL cholesterol, are examples of lipid disorders, often known as dyslipidemias, which are anomalies of lipoprotein metabolism. These conditions may be inherited or acquired (for example, familial hypercholesterolemia).
Those aged 20 years and older who have never been diagnosed with dyslipidemia are subjected to screening for diagnosis and treatment. For this advice, the existence of any of the specified risk factors constitutes increased risk. Several different variables increase the likelihood of developing CHD. The approach the USPSTF utilized in developing these recommendations relied on a 10-year risk of cardiovascular events, even though it did not use a particular numerical chance for this recommendation:
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Diabetes mellitus.
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CHD or noncoronary atherosclerosis in the past, such as peripheral artery disease, abdominal aortic aneurysm, and carotid artery stenosis.
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Cardiovascular disease in male relatives before age 50 or in female relatives before age 60.
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Nicotine use.
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Obesity (body mass index of 66 pounds per square meter or more).
How Is the Screening for Lipid Disorders Carried Out?
Total cholesterol and HDL values are the primary screening assays for dyslipidemia in nonfasting or fasting samples. Triglycerides should be a part of the initial tests used to regularly screen for dyslipidemia, although there is currently inadequate research to support this claim. The two outcomes' averages should be considered for risk assessment if abnormal screening test results are verified by a repeat sample on a different occasion.
If the available laboratory facilities cannot provide accurate measures of HDL cholesterol, testing total cholesterol alone is appropriate for screening. However, estimating CHD risk is more sensitive and specific when total cholesterol and HDL cholesterol are measured together. In addition to assessing HDL cholesterol, measuring LDL or total cholesterol would yield comparable results, albeit LDL cholesterol measurement is more expensive and necessitates a fasting sample.
Another established measurement used in trials for risk assessment and treatment decisions is calculated LDL cholesterol, total cholesterol minus HDL cholesterol minus triglycerides, divided by 5. Direct LDL cholesterol testing, which does not require a fasting sample measurement, is now available.
How Frequently Should Screen for Lipid Disorders Done?
Uncertainty surrounds the ideal screening interval. Based on other recommendations and professional judgment, feasible possibilities include:
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Every five years.
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Shorter intervals for those whose cholesterol levels are on the cusp of therapy-required levels.
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Longer intervals for people not at higher risk who have repeatedly had normal lipid levels.
What Is the Appropriate Age for Screening Lipid Disorders?
A cutoff age for screening has yet to be determined. When an older person has never been examined, screening may be acceptable; recurrent screening is less crucial because lipid levels are less likely to rise after age 65. Yet, compared to younger adults, older adults stand to profit more directly from the treatment of dyslipidemia because they have a higher baseline risk of CHD.
What Are the Treatment Options for Lipid Disorders?
Instead of focusing only on cholesterol levels, treatment options should consider a person's entire risk of heart disease. Age, sex, blood pressure, diabetes, increased blood sugar levels, family history (in younger persons), and smoking should all be considered when determining overall risk. Tools that estimate cardiovascular risk by counting the number of risk variables are less accurate than risk calculators that include precise information on various risk factors.
Diet alone is typically less successful than drug therapy for lowering lipid profiles. Still, patients' preferences, absolute risk, and treatment costs should be considered when selecting a course of action.
Drugs are frequently required to reach therapeutic goals, especially for those at higher risk of CHD. Even though lifestyle modifications such as diet and physical activity are effective beginning therapy for most patients, only a minority obtain significant reductions in cholesterol levels through changes in diet alone.
Interventions targeting all modifiable risk factors for heart disease, such as quitting smoking, managing blood pressure, diabetes, and obesity, and promoting a balanced diet and regular exercise, should be used with lipid-lowering therapies. The importance of long-term therapy adherence should be highlighted.
Conclusion:
Screening for lipid disorders primarily encourages lifestyle changes that have long-term advantages. To inform young adults about the benefits of a healthy diet and regular exercise; however, screening is optional because the average effect of diet interventions is small. Although universal screening may identify familial hyperlipidemia in some patients more quickly than selective screening, it is unknown whether this will result in significant drops in coronary events.
