Dyslipidemia is an imbalance in the ratios of various cholesterol fractions that does not manifest itself as a specific clinical symptom, but is a provocateur of the development of various pathological conditions in the human body. Thus, as an independent disease, dyslipidemia is not considered doctors, but this pathological condition is provocative in relation to the development of such chronic pathology as atherosclerotic vascular lesions. Dyslipidemic disorders inevitably lead to the formation of fat layers on the inner wall of the vessels, which complicates the adequate flow of blood through them and provokes hemodynamic damages of organs and tissues.
Causes of dyslipidemia
The appearance of dyslipidemia can be observed under various conditions, for example, in pathological conditions accompanied by activation of the process of fat synthesis, as well as excessive intake of them with food. In addition, the imbalance in the ratio of fat particles in the body can be triggered by a violation of their cleavage and excretion from the body, which can occur even if their insignificant intake into the body with food.
Depending on the pathogenetic mechanisms of dyslipidemic imbalance, several etiopathogenetic forms of dyslipidemia are distinguished. All hereditary forms of dyslipidemia belong to the primary and are divided into monogenic (the emergence of dyslipidemia develops as a result of the transfer of the defective gene to the child from one or both parents suffering from this pathology) and polygenic (the development of dyslipidemia is due not only to the transmission of the defective gene, but also to the negative influence of the environment) .
The secondary form of dyslipidemia is the most difficult to diagnose, since the onset of it is due to some chronic pathology that the patient has. Background diseases that can provoke the development of this or that pathogenetic form of dyslipidemia are: hypothyroidism , diabetes mellitus and various diffuse diseases of the hepatic parenchyma.
The diagnosis of "dyslipidemia alimentary" is established on the basis of the available fact of excess intake of cholesterol into the human body through food. This variant of dyslipidemia can proceed along a transient type, in which the increase in cholesterol occurs for a short time and is due to a single intake of a large volume of fatty foods, or as a permanent dyslipidemia.
The disease "dyslipidemia", as a rule, is established only with a continuous increase in the indices of cholesterol fractions in the blood, despite the fact that this pathology affects a significant part of the population throughout the world.
Symptoms of dyslipidemia
In connection with the fact that dyslipidemia is exclusively a "laboratory diagnosis", that is, its diagnosis is possible only on the basis of laboratory test results, the clinical symptomatology in terms of diagnostic criteria does not take a leading position. However, experienced specialists, even with a visual examination of a patient who has been suffering from dyslipidemia for a long time, may suspect this disease. One of these specific clinical markers are xanthomas , which are small seals on the surface of the skin, the preferred location of which is the plantar surface of the feet, skin of the back, joints of the hands and knees.
Excessive accumulation of cholesterol in the form of various fractions is accompanied by the formation of xantelasm , which are neoplasms on the eyelids of various sizes, yellow, dense structure, the internal content of which is cholesterol.
Hereditary form of dyslipidemia is characterized by the formation of a lipoid arch of the cornea, which is a whitish rim, located along the outer contour of the cornea of the eye.
Despite the scarcity of the clinical picture, the diagnosis of dyslipidemia is not difficult even in outpatient settings and includes a complex of laboratory studies of various orientations. The most priority laboratory analysis on which the doctor relies while diagnosing "dyslipidemia" is the so-called "lipid profile of the patient". Lipidogrammy means the determination of the concentration of various fractions of cholesterol and the determination of the coefficient of atherogenicity, indicating an increased risk of developing atherosclerotic disease in the patient. Due to the fact that the majority of clinical forms of dyslipidemia are hereditary pathologies, at present genetic examination of patients with identification of defective genes is a standard survey.
Types of dyslipidemia
The international classification of dyslipidemia is developed on the basis of data on which of the fat fractions is elevated in the patient's blood. Thus, all dyslipidemias are divided into isolated ones, in which there are increased indices of lipoproteins, which are cholesterol fractions, and combined, which not only increase cholesterol but also triglycerides.
A more advanced version of the division of dyslipidemia is the classification of Fredrickson, according to which five types of this pathology are distinguished.
Hereditary primary hyperchylomicronemia, or type 1 dyslipidemia, is accompanied exclusively by an increase in the level of chylomicrons, which are 90% composed of triglycerides and only 10% contain cholesterol. A favorable factor is that this variant of the course of dyslipidemia can not under any circumstances become a background for the development of atherosclerotic vascular and cardiac damage.
At 2a type of dyslipidemia, there is an increase in the indices of exclusively low-density lipoproteins, which refer to cholesterol fractions with a high level of atherogenicity. This variant of dyslipidemia is polygenic, that is, for the development of dyslipidemic imbalance it is necessary to combine the inheritance of a defective gene and the negative influence of environmental factors.
The difference 2b of the type of dyslipidemia is that the patient not only has elevated levels of low-density lipoproteins but also triglycerides.
3 type of dyslipidemia is characterized by the appearance in the patient of an elevated level of very low density lipoproteins, which is accompanied by an increased risk of developing atherosclerotic vascular lesions.
With the 4 type of dyslipidemia, there is also an increase in the indices of very low density lipoproteins, but the development of this condition is not due to a hereditary factor, but to endogenous causes.
For type 5 dyslipidemia, an increase in the chylomicron content in the blood is associated with an increase in the indices of very low density lipoproteins.
In connection with the variety of laboratory types of dyslipidemic disorders in the international classification, there are several forms of this pathology, however, dyslipidemia in μB 10 has a single E78 code.
Treatment of dyslipidemia
Medical measures aimed at eliminating manifestations of dyslipidemia are very diverse and include not only medical correction, but also compliance with dietician recommendations, lifestyle modification. Compliance with the recommendations of a non-pharmacological profile should take place both in hereditary forms of dyslipidaemia (in order to prevent the progression of the disease) and in the secondary version. Treatment of secondary dyslipidemia should begin with the elimination of the root cause of its occurrence, that is, compensation for chronic pathologies.
The main group of medicines, whose action is aimed at reducing the total level of cholesterol and various cholesterol fractions, are statins and bile acid sequestrants. The drugs of choice for correcting the elevated level of triglycerides and very low density lipoproteins are fibrates and nicotinic acid.
Preparations of the group of statins are antibiotic-monocalin, the action of which is directed to a specific suppression of the activity of the enzyme, which enhances the production of cholesterol fractions by the liver. Statins such as Lovastatin, Atorvastatin, Pravastatin can be developed both by microbiological and synthetic methods. Therapy of dyslipidemia with the use of statins is accompanied by a stable long-term decrease in the level of not only total cholesterol, but also low-density cholesterol, which is important in the prevention of atherosclerotic disease. Priority in the use of statins is also due to the fact that this group of drugs has not only a hypolipidemic effect, but also other pleiotropic effects in the form of improving endothelial function, suppressing inflammatory reactions in the vessels.
Hypocholesterolemic action is observed no later than three days after the start of statin use, but the maximum therapeutic effect is achieved only after 6 weeks of application of the drug. Perhaps the only negative effect of using statins is that after a complete discontinuation of the drug, the patient often has a reverse increase in the level of cholesterol, so the drugs of this pharmacological group must be taken constantly. Statins have no significant adverse reactions, but some patients with long-term use note the occurrence of dyspeptic disorders due to the development of drug damage to the liver.
Indications for the temporary cessation of hypocholesterolemic treatment with the use of statins is acute infectious damage to the body, surgical interventions, trauma, severe metabolic disorders. Absolute contraindication to the use of drugs of the statin group is a diffuse or focal lesion of the hepatic parenchyma and pregnancy . The initial therapeutic dose of statins is 20 mg, which should be taken once in the evening. The maximum dosage of these drugs is not more than 80 mg. Supportive hypocholesterolemic therapy is lifelong, and therefore, it is advisable to monitor transaminases in the blood once every 3 months.
In a situation where monotherapy with statins does not bring the desired effect, a combined treatment with the use of bile acid sequestrants, whose representatives is Kolestipol, cholesteramine at a dose of 4 g per day, is recommended. This group of drugs have an indirect effect on the synthesis of cholesterol, by increasing the excretion of bile acids from the body, which provokes the further formation of bile acids from cholesterol fractions. Absolute contraindication to the use of bile acid sequestrants is chronic colitis and significant hypertriglyceridemia.
With isolated hypertriglyceridemia, the drugs of choice are fibrates (Ciprofibrate in a daily dose of 100 mg). Due to the fact that the drugs of this pharmacological group can provoke the development of cholesterol stones in the cavity of the gallbladder, all patients who take long-term fibrates should undergo an ultrasound examination on a regular basis. In addition, with dyslipidemia type 5, combined with pancreatitis , Nicotinic acid is widely used in a daily dosage of 2 g. The only limiting factor that does not allow the widespread use of nicotinic acid in the treatment of dyslipidemia is its adverse reactions in the form of pronounced reddening of the skin of the upper half of the trunk and head .
In addition to the classical drug correction for severe dyslipidemic disorders, hemosorption and cascade plasma filtration are widely used, which are classified as extracorporeal methods for the therapy of dyslipidemia. These methods allow to change the qualitative composition of blood and can be used for patients of different age category, as well as pregnant women.
Despite the proven theory of the hereditary origin of most forms of dyslipidemia, genetic engineering still does not offer effective methods for treating primary dyslipidemia, so these techniques are only at the development stage.
The prognosis for recovery of patients suffering from dyslipidemia directly depends on the severity of dyslipidemic disorders, the rate of development of atherosclerotic vascular lesions and the localization of atherosclerotic plaques.
Modification of the eating behavior of a patient suffering from dyslipidemia is aimed at eliminating the risk of developing and progressing cardiac and vascular pathologies, improving the lipid profile, normalizing blood sugar, and preventing thrombosis.
The main risk group for the development of dyslipidemia is people with high nutritional status, so the primary therapeutic intervention should be the normalization of the patient's eating behavior. Dietary prescriptions state that a regular diet of a patient suffering from dyslipidemia should sharply limit the amount of animal fats. Reception of meat products is allowed not more often than once a week, and to enrich the body with protein should be in sufficient quantities to consume marine fish.
The main menu of patients with dyslipidemic disorders should be saturated with vegetable and fruit dishes containing fiber and important nutrients.
There is a controversial opinion that the use of alcohol favorably affects the prevention of atherosclerotic vascular disease. In fact, alcoholic beverages contain a colossal concentration of triglycerides, so their use with patients with dyslipidemia is strictly prohibited.
Prevention of dyslipidemia can be primary, when a person performs preventive measures before the appearance of metabolic disorders, and secondary, whose activities are aimed at preventing the development of possible complications in the form of atherosclerotic heart disease .
? Dyslipidemia - which doctor will help ? If there is or suspected the development of dyslipidaemia, you should immediately seek advice from such physicians as a cardiologist and gastroenterologist.