Dr Noureen Ahmad

General Practitioner, Belgium

Hyperlipidaemia is a condition when lipid or fat levels are high in the blood. This can be under the form of cholesterol and triglycerides. When there is a high lipid level, it cannot be removed properly from the blood. The excess fat is deposited in the blood vessels and keeps accumulating, affecting the blood flow and depriving blood and oxygen to organs such as the heart, brain and other organs. The long-term problems that this can cause are heart attacks and strokes, which can also be extremely fatal. 

Our blood contains different kinds of fat, like cholesterol. There is an LDL-cholesterol, which is known as the “bad” cholesterol as it transports cholesterol to cells and blood vessels and can start building up in the vessels causing blockage of the arteries. The HDL-cholesterol is the “good” cholesterol, which transports cholesterol back to the liver for it to be broken-down and excreted out of the body. Triglycerides are another type of lipids in the blood, which are a form of fat stored in the cells and used for energy, however high levels of these pose problems for the liver and pancreas as well as heart problems. 

The causes of hyperlipidaemia can be due to an unhealthy diet, smoking, alcohol, being overweight, less physical activity, diabetes mellitus and kidney, liver or thyroid insufficiency. Patients using steroids also have a high risk for developing hyperlipidaemia. In some families, there can be an underlying genetic disorder, which can lead to familial hypercholesterolemia (FH). FH can cause extremely high levels of cholesterol and can cause heart diseases at a very young age if left untreated. Usually FH is inherited and passed down through families. 

The diagnosis of hyperlipidaemia is made by evaluating the lipid levels of all the different type of fats in the blood. To exclude underlying causes, tests for thyroid, liver, kidney and blood glucose are also carried out.

Despite no acute clinical symptoms in the moment, after the diagnosis of hyperlipidaemia, it is necessary to treat the high lipid levels to prevent many diseases from occurring, which can seriously affect the life expectancy. 

Primary treatment of hyperlipidaemia depends on lifestyle changes. It is important to have a healthy diet and avoid saturated fats, usually found in butter, ghee, patisseries, cheese and red meat. The UK health guidelines recommend a maximum of 30 grams of saturated fat a day for the average man and a maximum 20 grams per day for the average woman. 

Monounsaturated fats like olive oil, avocados and nuts are thought to be able to lower the LDL levels and raise HDL in the blood. Food rich in omega-3 fatty acids such as oily fish (mackerel, salmon and herring) are also good for you and can reduce triglyceride levels in some people. However too much omega-3 fatty acids can contribute to obesity. Thereofore for people with a high triglyceride levels, at least 1-2 portions of oily fish a week is thought to be beneficial.

There are also supplements available containing fish oils and can be used in individuals who are unable to eat enough fish. Besides this, a good variety of fruits and vegetables can also lower the blood cholesterol, for instance, vegetables such as soybeans, lentils, okra, eggplants, potatoes and fruits like fresh figs, berries and apples. 

Recently, there has been cholesterol-lowering products such as margarines; these contain plant sterols (similar to cholesterol) and reduce the cholesterol absorption in the intestines. This can lead to a small decrease in the cholesterol blood level, but it is advised to avoid them as a long-term use, as it can also affect the absorption of the fat-soluble vitamins (vitamins A, D, E, K) from the intestines. 

Behavioural changes such as more exercise and smoking cessation can also lead to more production of HDL, the good cholesterol. 

In some circumstances, the doctor can start with medication for hyperlipidaemia. This is usually when lifestyle changes do not decrease the high lipids in the blood. A high cardiovascular risk such as smoking, being overweight, high blood pressure and diabetes mellitus can also lead to starting medication for hyperlipidaemia. These medications can be statins, fibrates and nicotinic acid.

Statins decrease high levels of cholesterol whereas fibrates and nicotinic acid are effective against triglycerides. 

The doctor will start medications based on the clinical condition of the patient followed by a control test after a few months to analyse the efficiency of the used medication. This treatment can be continued if an improvement is observed but blood check-ups are still required regularly. With no improvement, the dose of the medication can be elevated or other medications can be suggested or added to an existing treatment.

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