Overview: What is a dyslipidemia?
A lipometabolic disorder is when fats (lipids) contained in the blood have too high a concentration. There are fats produced naturally in the body and fats that we consume through food. They provide energy to the body. The fats are transported in the blood and reach other organs via the distributors liver and intestine. Disturbances in lipid metabolism can lead to other diseases – for example, one risk is that too many deposits (plaques) will attach to the edges of blood vessels due to elevated fat levels, causing them to narrow and, in the worst case, clog if the plaques break loose. An indication of disorders of lipid metabolism is provided by cholesterol and triglyceride levels – other fats are less likely to cause a disorder:
- If the cholesterol level is elevated, this is called hypercholesterolemia.
- If the triglyceride level is elevated, it is called hypertriglyceridemia.
If both lipid levels are elevated, this is called combined hyperlipidemia.
Lipid metabolism disorder: causes and risk factors
Cholesterol and triglycerides are hydrophobic, so to speak, and like all fats are not water-soluble. That is why they do not dissolve in blood. The blood can only transport fats and thus supply energy to the body if they become transportable. This occurs when fats that are not water-soluble bind to proteins. This creates lipoproteins (fat proteins) that can be distributed in the blood. Lipoproteins, which transport cholesterol, are divided into three categories:
- LDL (low-density lipoprotein): This form of lipoprotein contains cholesterol, which is passed on to the body’s cells. When there is excess LDL cholesterol in the blood, stocks are deposited on the walls of the arteries (blood vessels leading away from the heart). This process is also called calcification. Colloquially, LDL cholesterol is known as “bad” cholesterol, especially at elevated levels.
- HDL (High-Density Lipoprotein), very dense fat protein: This lipoprotein is the antithesis of LDL cholesterol and is referred to as “good” cholesterol. HDL cholesterol has the task of collecting excess cholesterol from the cells and organs and transporting it back to the liver, where it is disposed of. This process is intended to prevent narrowing of the blood vessels (arteriosclerosis).
- VLDL (Very-Low-Density Lipoprotein): VLDL transports triglycerides and cholesterol from the liver to the tissues. During transport, triglycerides are released and thus VLD lipoprotein (VLDL) becomes LD lipoprotein (LDL).
An analysis of the blood shows LDL and HDL levels in particular, and total cholesterol and triglyceride levels can also be determined. A lipometabolic disorder is present if one or more of these values are outside the normal range for a prolonged period of time.
A large part of the diseases is (co-)determined genetically. In these cases, we speak of a primary dyslipidemia. The five different types of this so-called hyperlipoproteinemia (HLP) are distinguished by different severity and distribution of symptoms.
Life circumstances such as lack of exercise, unfavorable diet or alcohol consumption increase the severity of the inherited disease.
Other cases are secondary lipometabolic disorders, these are triggered and / or favored by the lifestyle of the affected person or a previous disease. Possible causes are:
- Alcohol overconsumption
- Sugar disease (diabetes mellitus)
- Hypothyroidism (underactive thyroid gland)
- Liver disease
- Obesity (adiposity)
- Metabolic syndrome (combination of obesity, hypertension, insulin resistance in diabetes, dyslipidemia)
- Anorexia nervosa (Anorexia)
- Nephrotic syndrome (collection of various symptoms of diseases of the renal corpuscles).
Some of these diseases and conditions can be influenced by the affected persons themselves, an adapted behavior is recommended. In addition, various drugs or drug components can contribute to dyslipidemia. These include beta-blockers (for example, for heart disease), estrogens (for example, birth control pills), diuretics (water-purifying agents), or glucocorticoids (for example, cortisone). We will curb the possible unfavorable influence of such preparations by correcting medication and/or dose if necessary.
In order to be able to treat a lipometabolic disorder, it must first be recognized. This is often not very easy. In genetic diseases, characteristic nodules (xanthomas) appear in the longer course. Depending on the type of hyperlipoproteinemia, these small yellow-orange surface changes form on different parts of the body: chest, back, arms, buttocks, ears, eyes, elbows, knees, interdigital spaces or even internal organs, liver and spleen.
The appearance of nodules often leads to a visit to the doctor, as a result of which the cause is found. However, those who have no or only a few symptoms see no reason to seek medical advice. Only in the case of considerable consequential damage do they allow themselves to be examined. For some sufferers, the diagnosis first emerges during treatment for cardiovascular disease. Symptoms of a long-standing and massive dyslipidemia may include:
- Clouded whitish ring in eye
- Upper abdominal pain (due to inflammation of the pancreas or liver)
- Chest pain (angina pectoris) and/or left arm or leg pain (PAD) due to fatty deposits in arteries (arteriosclerosis)
- Significant blockage of arteries, also called peripheral arterial occlusive disease (PAVK).
- Heart attack
- Pain (especially during movement) of the legs (possible circulatory disorder due to arteriosclerosis)
Lipid metabolism disorder: diagnosis by us
The development of symptoms in dyslipidemia is gradual and often reveals the disease at a late stage. From the mid-30s onwards, it is therefore advisable to have blood values checked regularly. These analyses measure total cholesterol, LDL cholesterol and HDL cholesterol. If one or more values are elevated, we check other causes for the critical values. In addition, we look for other risk factors by means of ECG (electrocardiogram), blood pressure and blood sugar measurement. Then we will target the lipid metabolism disorder. If you, as an affected person, observe single or multiple symptoms in yourself, you should consult us promptly.
At the USZ, lipid metabolism disorders are performed under the responsibility of recognized experts in this field. The treatment of complex cases is carried out in an interdisciplinary team, i.e. specialists from different disciplines (for example metabolic medicine, cardiac medicine and vascular medicine) discuss the cases and find the best possible therapy proposal.
Lipid metabolism disorder: prevention, early detection, prognosis
You can prevent a lipometabolic disorder yourself by paying attention to a healthy lifestyle. These include the following measures:
- a healthy and conscious diet
- a consumption of alcohol as low as possible
- sufficient exercise, optimally in the fresh air
- the avoidance of stress
- Overweight reduction
- Abstaining from nicotine and other drugs
Since the health consequences of a lipometabolic disorder usually only become apparent at a late stage, many sufferers do not react until the first damage, for example to the blood vessels, has already become apparent. Therefore, the best chance of minimizing the risks is to detect them as early as possible. Experts therefore recommend regular blood tests from the age of 35.
Course and prognosis of dyslipidemia
The earlier a lipometabolic disorder is detected, the more consequential damage can be alleviated or avoided through appropriate lifestyle changes or drug therapies. Typical consequences of a disturbance of the fat metabolism are
- Diseases of the cardiovascular system such as angina pectoris, a heart attack or stroke
- Damage to various organs such as liver
In the death statistics of Central Europe, cardiovascular diseases as a result of lipometabolic disorders are among the frequent causes of death. It is estimated that in Central Europe about one in two people over the age of 40 has elevated blood lipid levels. However, positive disease development is possible through a health-oriented lifestyle.
Lipid metabolism disorder: possible treatment
Treatment is aimed at lowering blood lipid levels again. Basically, a healthy lifestyle helps regulate fat metabolism. However, this is not always possible. In addition, medications can lower blood lipid levels.