Understanding Lipid Disorders

Is Cholesterol important?
Cholesterol plays an important role in the production of steroid hormones and bile acids. It is also a key component in the structure of cells that make up our bodies. However, too much of cholesterol is bad since it increases our chances of developing heart diseases.

Cholesterol is transported in the blood while attached to compounds called lipoproteins. The two main lipoproteins are:

• Low-Density Lipoprotein cholesterol (LDL-C) also referred to as ‘bad cholesterol’ because when in excess, it is responsible for transporting cholesterol to our arteries where it builds up and increases our risk of heart diseases.
• High-Density Lipoprotein Cholesterol (HDL-C) also referred to as ‘good cholesterol’ because it is responsible for carrying cholesterol from the arteries back to the liver thus reducing our risk of heart diseases.
• Triglycerides are Fats that are transported by other lipoproteins and they also increase our risk of heart diseases and pancreatitis if in excess.

Any imbalance in the levels of these lipoproteins and/or fats(triglycerides) in blood is termed as a lipid disorder (dyslipidemia) and it increases our risk of developing heart diseases.

What constitutes a lipid disorder?
A lipid disorder is characterized by either one or a combination of the following:

• High cholesterol levels – High levels of Low-Density Lipoprotein cholesterol (LDL-C) or Total Cholesterol
• High triglyceride levels – High levels of fats in the blood
• Low concentrations of High-Density Lipoprotein Cholesterol (HDL-C)

Watch this video by American Heart Association for an audio-visual representation:

Image courtesy of NHLBI

What factors increase my risk?
Your chances of developing lipid disorders are increased if you:

• Are Diabetic
• Are obese/overweight
• Have a family history of lipid disorders
• Follow a diet rich in saturated and/or trans fats and highly processed foods
• Are not physically active
• Are a smoker
• Have an underactive thyroid
• You are older (45 years and above)

Also, depending on your heart disease risk level, the doctor will decide whether to use lifestyle interventions, drug therapy or a combination of both to address the lipid disorder in question (higher risk levels necessitate initiation of immediate drug therapy).

Factors that may elevate your risk of developing heart disease include:

• Being 65 years of age or older
• Family history of lipid disorders
• Being Diabetic
• Being hypertensive
• Having Chronic Kidney Disease
• Being a smoker
• History of congestive heart failure
• History of prior coronary bypass surgery
• Being HIV +

Lifestyle interventions for lipid disorders

1. Dietary intervention – following a heart healthy diet
2. Increasing physical activity
3. Weight loss if overweight/obese
4. Smoking cessation
5. Limit alcohol consumption

1. Dietary interventions
   The diet should contain monounsaturated and polyunsaturated fatty acids (MUFA and PUFA), which have a protective effect against atherosclerosis. Good sources of these include Nuts (groundnuts, cashew-nuts, peanuts, almonds etc.); seeds (Flax, chia, pumpkin, sunflower etc.) and fish.
   Patients should reduce the consumption of saturated fats such as those found in processed foods and animal meat. Total cholesterol intake should be limited to less than 200 mg/day. It is also important to reduce the intake of Trans Fatty Acids which have a negative effect on the levels of LDL, HDL, and triglycerides. In addition, the Trans Fatty Acids can increase insulin resistance. Therefore, people should reduce consumption of fried and baked foods such as cookies.
   People who are vulnerable or suffering from lipid disorders should be encouraged to increase consumption of:
   • Fruits and vegetables
   • Whole grain cereals
   • Low fat dairy products
   • Oily fish

   Fish oil lowers the level of triglycerides and risks of stroke. It is recommended that patients should maintain the intake of omega 3 oils to 7 grams per week. Therefore, they should increase their servings of oily fish.
   Increased consumption of soya is also touted as beneficial against lipid disorders because it is rich in isoflavones. When combined with prebiotic drinks soya suppresses the level of LDL-cholesterol. The isoflavones improve how the blood circulatory system works and the condition of blood vessels.
   Cocoa products provide flavonoids that reduce blood pressure and cardiovascular disease risk. Dark chocolate and cocoa products are credited with normalizing the level of LDL cholesterol.
   Green tea provides polyphenols which reduces the total cholesterol and LDL cholesterol. Therefore, green tea can prevent cardiovascular diseases from becoming severe.

2. Physical Activity
   Regular physical activity increases HDL cholesterol and leads to an improvement in lipid profile. Besides, physical activity reduces insulin resistance and blood pressure. It is important to engage in 30 minutes of moderate intensity physical activity three or four times a week. For the best results, it is recommended to combine physical activity and dietary interventions. Aerobic exercises and resistance training improve the lipid profile.
3. Weight Reduction
   Obese and overweight individuals should undertake weight reduction measures because it lowers LDL cholesterol. Individuals who have a Body Mass Index of ≥30 kg/m2(obesity) or 25-29.9 kg/m2(overweight) should join weigh loss programs especially if they are exposed to more than 2 risk factors. Men and women should strive to have a waist circumference of >102 and >88 cm respectively.
4. Smoking Cessation
   Smoking is associated with high cholesterol levels and cessation has a major impact on the risk of cardiovascular diseases. For instance, smoking increases the levels of total cholesterol and LDL cholesterol while reducing the level of HDL cholesterol. Available interventions include nicotine replacement and individual counselling.
5. Alcohol consumption
   Moderate alcohol intake increases the level of HDL cholesterol and suppresses the level of cardiovascular biomarkers. However, excess alcohol consumption remains dangerous and it is advisable to limit intake to 2 and 1 standard drink for men and women respectively.

In instances where lifestyle interventions alone are not enough to control dyslipidemia, or the risks are too high, medication such as statins can be prescribed by your doctor.