Dyslipidemia

Understanding Dyslipidemia (Hyperlipidemia)

Understanding Dyslipidemia (Hyperlipidemia)

Dyslipidemia is a metabolic disorder characterised by abnormal lipids, also called cholesterol levels in the blood. Different forms of fat content are essential lipids that play important roles in the body; cholesterol is necessary for cell structure, hormone synthesis, and bile production, while triglycerides are a primary energy source. However, if the levels are elevated, it can lead to cardiovascular risks like heart attack or stroke. Conditions typically involving lipid abnormalities are 

  1. Elevated LDL cholesterol (low-density lipoprotein) – Often called “bad cholesterol,” high levels can lead to plaque buildup in arteries, increasing the risk of heart disease and stroke.
  2. Low HDL cholesterol (high-density lipoprotein)—Known as “good cholesterol,” HDL helps remove excess cholesterol from the bloodstream. Low levels, especially in smokers, are a risk factor for cardiovascular disease.
  3. Elevated triglycerides –  High triglyceride levels can cause pancreatitis.
  4. Elevated total cholesterol – A general increase in cholesterol levels can indicate a problem with lipid metabolism.

Causes and Risk Factors of Dyslipidemia

Dyslipidemia can be caused by genetic factors, lifestyle choices, or a combination of both. The following are some common risk factors:

  • Genetic Predisposition: Some individuals inherit genes that cause high cholesterol or high triglycerides, this condition is called familial hypercholesteraemia 
  • Unhealthy Diet: Eating a lot of food high in fats, trans fats, and sugar(carbohydrates) can raise cholesterol and triglyceride levels.
  • Lack of Physical Activity: A sedentary lifestyle is one of the contributing factors to the high levels of bad cholesterol and low levels of good cholesterol.
  • Obesity: Body mass index (BMI) of 23 or greater is linked to high bad cholesterol and low good cholesterol, as well as high triglycerides.
  • Smoking: Smoking reduces HDL (good) cholesterol by altering lipid metabolism, leading to decreased HDL levels and impaired function of HDL particles.
  • Age and Gender: Cholesterol levels naturally rise as you age, and men tend to have higher LDL (bad) levels than women until menopause, after which LDL levels in women can rise higher.
  • Comorbidities: High cholesterol levels are seen in patients who have diabetes mellitus.

Less prevalent symptoms may include nausea, vomiting, and a sweet smell on the breath, often described as fruity. These are signs of possible diabetic ketoacidosis, a life-threatening condition that needs immediate medical attention.

Causes and Risk Factors of Dyslipidemia
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Symptoms and Signs of Dyslipidemia

Dyslipidemia itself may not cause any direct symptoms, but it can result in symptomatic cardiovascular diseases like heart attack and stroke. Certain physical signs might suggest its presence:

  • Xanthomas: Fatty deposits under the skin or around the eyelids. They appear as tiny, yellowish bumps or nodules and usually affect the elbows, knees, tendons, or eyes. 
  • Corneal Arcus: A grey or white arc or ring around the cornea of the eye, which can be particularly telling in younger individuals.
  • Peripheral Arterial Disease: While not a direct symptom, reduced circulation leading to symptoms such as leg pain when walking (claudication) might be a clue to underlying dyslipidemia.

Moreover, dyslipidemia is frequently discovered during a routine blood test.

Diagnosis of Dyslipidemia

It is advisable for people with the aforementioned symptoms to undergo diagnostic tests for dyslipidemia. Harmony Thyroid, Endocrinology and Diabetes Centre offers the following tests:

  • Lipid Profile Test: A blood test, called a lipid panel, is ordered. This test measures key lipid levels:
    • Total cholesterol (TC)
    • Low-density lipoprotein cholesterol (LDL-C)
    • High-density lipoprotein cholesterol (HDL-C)
    • Triglycerides (TGs) 
  • Additional Markers: Sometimes, secondary lipid markers such as apolipoprotein B and lipoprotein(a) may be measured to predict the risk of heart issues and stroke.
  • Risk Factor Assessment: Endocrinologists assess other risk factors, such as comorbid conditions (e.g., diabetes or hypothyroidism), that might contribute to abnormal lipid levels.
  • Monitoring After Treatment: Regular blood tests are done after treatment begins, typically 2-3 months later, to track improvements in lipid levels.

Our experienced Endocrinologist Dr Vikram will explain the test findings to you.

As dyslipidemia is generally asymptomatic, certain groups of people should still get screened for the disease even if they have no symptoms. For adults without significant risk factors for cardiovascular disease, lipid screening (including total cholesterol, LDL-C, HDL-C, and triglycerides) can typically be performed every 4 to 6 years. People with risk factors for dyslipidemia, such as diabetes, hypertension, or a family history of early heart disease, may require more frequent testing. For such individuals, lipid testing might be recommended more frequently, such as annually or biannually.

Managing and Treating Dyslipidemia in Singapore

The treatment of dyslipidemia is tailored to the specific type and severity of the lipid imbalance while also considering any accompanying risk factors such as diabetes, hypertension, obesity, or smoking. Endocrinologists typically recommend lifestyle modifications, such as dietary changes and exercise, and may prescribe lipid-lowering medications as part of the comprehensive management of the condition.

Managing and treating dyslipidemia effectively involves both lifestyle modifications and, potentially, medications:

Lifestyle Modifications

Lifestyle Modifications

  • Diet: Eating a diet low in saturated and trans fats and loaded with fruits, vegetables, and whole grains can help correct imbalanced lipid levels.
  • Exercise: Regular physical activity can reduce LDL cholesterol and triglycerides while raising HDL cholesterol.
  • Weight Management: Attaining and sustaining a healthy weight can significantly improve lipid profiles.
  • Smoking Cessation: Quitting smoking can raise HDL cholesterol and improve overall cardiovascular health

Medications

The primary objectives of prescribing medication are to decrease levels of LDL cholesterol, increase HDL cholesterol, and reduce triglycerides. 

  • Statins: These drugs are typically the first line of treatment for high LDL cholesterol. They work by disrupting cholesterol production in the liver. 
  • Fibrates: Typically used to lower triglyceride levels and increase HDL cholesterol.
  • Niacin: This can help reduce LDL and triglycerides and boost HDL levels.
  • Cholesterol Absorption Inhibitors: These lower the amount of dietary cholesterol absorbed by the intestines.

Dyslipidemia, which is characterised by abnormal amounts of lipids (fats) in the blood, is often associated with and can be caused by other hormonal disorders such as diabetes mellitus and thyroid diseases. Thus, the treatment often includes managing the underlying hormonal condition, which can have a significant impact on lipid levels. 

Dr Vikram Sonawane

If you are suffering from symptoms of dyslipidaemia, such as fatty deposits under the skin and a grey ring around the eye’s cornea, it is advisable to schedule an appointment with our Medical Director and Senior Consultant Endocrinologist, Dr Vikram from Harmony Thyroid, Endocrinology, and Diabetes Centre.

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