Pathophysiology of Hyperlipidemia

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Abnormally elevated levels of any or all lipids and / or lipoproteins in the blood. (Cholesterol and triglycerides) It is the most common form of Dyslipidemia (which includes any abnormal lipid levels)

Check for symptoms:

  •     Fat deposits in the skin or tendons.
  •    Pain, enlargement, or swelling of organs such as the liver, spleen, or pancreas.( Pancreatitis )
  •    Obstruction of blood vessels in heart and brain
  • If not treated, high lipids can cause
  •    Heart Attack
  •    Stroke
  •    Atherosclerosis (hardening of the arteries)
  •    Coronary Artery disease

                                        Normal Levels                                                     Risk factor

Triglycerides

>150 mg/dl

150-199 mg/dl

200-499 mg/dl

HDL Cholesterol

60 mg/dl

35-45 mg/dl

 

LDL Cholesterol

60-130 mg/dl

130-159 mg/dl

160-189 mg/dl

Drugs and Dosage:

HMG CoA Reductase Inhibitor

Once a day. Should be taken after meal at night

  • Atorvastatin: –

Dosage forms:  5mg,10mg,20mg, 40mg or 80mg

Dose necessary to achieve recommended 30–40% reduction of LDL-C: 10 mg

  • Rosuvastatin:

Dosage forms:  5mg,10mg,20mg or 40mg

Dose necessary to achieve recommended 30–40% reduction of LDL-C: 5–10 mg

  • Simvastatin:

Dosage forms:  5mg,10mg,20mg, 40mg or 80mg

Dose necessary to achieve recommended 30–40% reduction of LDL-C: 20–40 mg


 Fibrates:

  • Fenofibrate: Should be taken after meal at night or Once a day . 34–201 mg orally once/day. May be safest fibrate for use with statins. To treat high levels of cholesterol & TG s with an increased  risk of atherosclerosis.

  • Gemfibrozil: 30 min before morning and evening meals high cholesterol and triglycerides who have not been helped by other treatment methods 600 mg Orally twice a day. Used in patients with Pancreatitis. Contraindicated with ezetimibe /simvastatin,sitagliptin,metformin.

Cholesterol absorption inhibitor:

  • Ezetimibe: 10 mg oral once/day.

Combination of Drugs:

  • Ezetimibe 10 mg+Atorvastatin 10,20,40,80 mg Orally Once a Day.

  • Ezetimibe  10mg+Simvastatin 10,20,40 mg Orally Once a day.

  • HMG CRI+FIBRATES

Counselling on side effects:

  • Patients with statins may get muscle pains, in case of the event recommend Coenzyme supplements  intermittently, combination of statins and fibrates may cause gallstones, which require treatment through medication (ursodeoxycholic acid – Udliv brand) or surgical removal.
  • People who are overweight or trying to lose weight quickly are more likely to develop gallstones, symptoms are mild pain in pit of stomach or upper right part of belly, can be diagnosed using ultrasound.

Counselling on Diet:

  1. Olive oil: Switch to olive oil for cooking. Olive oil contains a mix of various anti-oxidants which lower your bad cholesterol (LDL). Use it for your tadka or add it as a dressing to salads.

  2. Nuts: Walnuts and almonds are rich in omega three fatty acids and PUFA (polyunsaturated fatty acids) which help reduce LDL cholesterol and keep the blood vessels healthy

  3. Oats: Being high in soluble fibre, oats reduce the absorption of cholesterol (Total & LDL) in your blood. Eating 1 ½ cups of cooked oats with milk and bananas or apples gives you your daily requirement of soluble fibre.

  4. Fish: High in omega 3 fatty acids, it helps increase the levels of the good (or HDL) cholesterol.

  5. Garlic: Though the cholesterol lowering effects of garlic has been debated in recent times, it has been shown that allicin in the garlic does help.

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