What is Dyslipidemia?
Dyslipidemia is an imbalance in lipids levels that normally manifests as high total cholesterol, high LDL-C, low HDL-C and high triglycerides. Such imbalances increase the risk of contracting cardiovascular diseases. Cholesterol is a major component of cell membranes, bile acids, and steroid hormones. It is transported in the blood while attached to lipoproteins. The cholesterol can be deposited on the walls of the arteries thereby causing atherosclerosis.
Pharmacological Interventions against Dyslipidemia
There are several drugs that are useful in the treatment of dyslipidemia.
Examples include:
- Statins (Lovastatin, Pravastatin, Simvastatin, Fluvastatin, Atorvastatin, and Rosuvastatin)
- Fibrates (Gemfibrozil, Fenofibrate, and Colifibrate)
- Bile acid binding resins (Colestramine, Colestipol, and Colesevelam)
- Nicotinic acid (Niacin)
- Ezetimibe
- Omega 3 fatty acids
Statin
Statin is widely used in the management of dyslipidemia and it works by inhibiting a major enzyme that is critical for manufacturing cholesterol in the liver. The drug promotes the removal of LDL-C from circulation. However, it has minimal impact in the reduction of triglycerides and increase of HDL-C. Simvastatin, Atorvastatin, and rosuvastatin are the most effective in lowering LDL-C. They should be administered once a day together with the evening meal because the synthesis of cholesterol is highest at night. Since atorvastatin has a long half-life, it can be taken anytime during the day, preferably in the morning. Most statins have a short half-life and can be combined with bile acid resins, niacin, and omega 3 fatty acids.
The side effects that are associated with statins include:
- Constipation
- Increase in liver enzymes
- Muscle aches and weaknesses
Fibrates
Fibrates are effective at lowering triglyceride and increasing HDL-C levels. However, their impact at lowering HDL-C levels is modest. The drug acts by limiting the level of triglyceride-rich lipoproteins from the blood.
Common side effects of Fibrates include:
- Stomach problems
- Enhancing the muscle toxicity attributed to statins
- Development of gallstones
Bile acid binding resins
Bile acid-binding resins have minimal effects on the stomach and on the level of LDL-C. The resins increase the level of HDL-C mildly. In some people, it increases the level of triglycerides and production of VLDL in the liver. They act by binding to bile acids in the intestines and promoting faecal excretion. The drugs are not absorbed in the stomach because they are largely insoluble in water. They should be taken with meals after hydrating with water to reduce the gritty texture. Bile acid resins produce the best results when administered in combination with other drugs, especially statins.
Its side effects include:
- Abdominal pain
- Constipation
- Nausea
- Flatulence
- Interference with the absorption of fat-soluble vitamins
Nicotinic acid
Nicotinic acid (Niacin) is effective against all major lipids and acts by preventing lipolysis in the adipose tissue, which is normally responsible for the high levels of free fatty acids. The drugs limit the synthesis of triglycerides, very low-density lipoproteins, and LDL.
Side effects associated with niacin include:
- Flushing of the skin
- Liver dysfunction
- Reduced glucose tolerance
- Intestinal disturbances
People who are suffering from chronic liver disease, severe gout, and type 2 diabetes should not be put on niacin.
Ezetimibe
Ezetimibe selectively prevents absorption of cholesterol in the intestines. The drug lowers LDL-C, triglycerides, and total cholesterol. Besides, it raises the concentration of HDL-C and is extremely effective when administered together with statins. Ezetimibe reduces the synthesis of cholesterol by the liver.
Open Heart Surgery
The heart works like a pump and distributes blood throughout the body. It is supplied with blood through coronary arteries. When these arteries are blocked then it becomes necessary to conduct coronary bypass surgery. During the procedure, a bridge is created to bypass the section of the coronary artery that is blocked.
Nonpharmacological Therapy
Dietary therapy should be characterized by:
- Limiting intake of saturated fat and cholesterol
- Increasing consumption of monosaturated and polyunsaturated fatty acids from sources such as olive oil, canola oil, and fatty fish
- Eating dietary fiber and complex carbohydrates from whole grains, beans, and cereals
Omega 3 fatty acids should be used to treat patients who have high levels of triglycerides. It helps to lower the amount of cholesterol, triglycerides, and LDL while raising the amount of HDL-C. Dyslipidemia patients should increase intake of omega 3 fatty acids such as α-linoleic acid from flaxseed oil, canola oil, nuts, and green leafy vegetables. Polyunsaturated fatty acids such as eicosapentaenoic acids have anti-inflammatory properties.
People who are suffering from dyslipidemia should engage in physical activity for 30 minutes at least 5 times a week. Those who are overweight should strive to lose weight while smokers need to quit the vice.
