Lipid Disorders Contributions by FoundHealth

Lipid disorders are abnormalities in the amount of fatty substances, called lipids, in the blood. Cholesterol and triglycerides are two types of lipids measured. These lipids are involved in many body processes.

High cholesterol levels are associated with an increased risk of coronary heart disease , hardening of the arteries (atherosclerosis), and stroke . A total cholesterol level of less than 200 mg/dL* (5.2 mmol/L) is desirable, 200-239 mg/dL (5.2-6.1 mmol/L) is borderline high, and over 239 mg/dL (6.1 mmol/L) is high.

*mg/dL = milligrams per deciliter blood (mmol/L = millimoles per liter blood)

Plaque Due to Build-up of Lipids in an Artery

There are two main types of cholesterol:

• High-density lipoprotein (HDL) cholesterol—This is often referred to as the "good" cholesterol, which helps protect against heart disease. It is believed to carry cholesterol to the liver and away from arteries. Levels of 60 mg/dL (1.6 mmol/L) or higher are beneficial in lowering heart-disease risk.
• Low-density lipoprotein (LDL) cholesterol—This is often referred to as the "bad" cholesterol, which increases the risk of heart disease. High levels allow plaque to build up in your arteries. Levels less than 100 mg/dL (2.6 mmol/L) are considered optimal.

Triglycerides also contribute to heart disease in some people. Levels above 199 mg/dL (2.2 mmol/L) are considered high and may require treatment.

Factors such as heredity, certain drugs and diets high in saturated fat, can lead to unhealthy elevations in lipid levels. Large amounts of carbohydrates or alcohol may also lead to high lipid levels.

According to the American Heart Association, 106.7 million Americans over the age of 20 have a total cholesterol of 200 mg/dL (5.2 mmol/L) or higher. Certain diseases such as diabetes mellitus, hypothyroidism, or the nephotic syndrome can be associated with elevated lipid levels.

What are the risk factors for lipid disorders?

[What are the symptoms of lipid disorders?

[How are lipid disorders diagnosed?

[What are the treatments for lipid disorders?][7]

Are there screening tests for lipid disorders?

[How can I reduce my risk of lipid disorders?

[What questions should I ask my doctor?

Where can I get more information about lipid disorders?

American Heart Association (AHA)

Address:

National Center
7272 Greenville Ave.
Dallas, TX 75231

Phone:

1-800-242-8721

Internet Address:

http://www.americanheart.org

Description of Services Provided:

The American Heart Association provides educational materials about high cholesterol and other heart disease risk factors. This national voluntary health agency’s mission is to reduce disability and death from cardiovascular diseases and stroke.

American Family Physician

Address:

11400 Tomahawk Creek Pkwy
Leawood, KS 66211

Internet Address:

http://www.aafp.org/

Description of Services Provided:

Provides informational sheets on health topics and disease management.

The National Heart, Lung, and Blood Institute (NHLBI)

Address:

Building 31, Room 5A48
31 Center Drive MSC 2486
Bethesda, MD 20892

Phone:

1-301-592-8573

Internet Address:

http://www.nhlbi.nih.gov

Description of Services Provided:

The NHLBI is a part of the National Institutes of Health. The site provides information about cholesterol, heart disease risk factors, and various heart conditions. The institute conducts and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases as well as sleep disorders.

National Institutes of Health

Cholesterol Guidelines (2002):

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report.NIH Publication No. 02-5215. September 2002.

Internet Address:

http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Center for Health Statistics website. Available at: http://www.cdc.gov/nchs/ .

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

Pejic RA, Lee DT. Hypertriglyceridemia. JABFM.2006;19:310-316.

Lipid disorders are abnormalities in the amount of fatty substances, called lipids, in the blood. Cholesterol and triglycerides are two types of lipids measured. These lipids are involved in many body processes.

High cholesterol levels are associated with an increased risk of coronary heart disease , hardening of the arteries (atherosclerosis), and stroke . A total cholesterol level of less than 200 mg/dL* (5.2 mmol/L) is desirable, 200-239 mg/dL (5.2-6.1 mmol/L) is borderline high, and over 239 mg/dL (6.1 mmol/L) is high.

*mg/dL = milligrams per deciliter blood (mmol/L = millimoles per liter blood)

Plaque Due to Build-up of Lipids in an Artery

There are two main types of cholesterol:

• High-density lipoprotein (HDL) cholesterol—This is often referred to as the "good" cholesterol, which helps protect against heart disease. It is believed to carry cholesterol to the liver and away from arteries. Levels of 60 mg/dL (1.6 mmol/L) or higher are beneficial in lowering heart-disease risk.
• Low-density lipoprotein (LDL) cholesterol—This is often referred to as the "bad" cholesterol, which increases the risk of heart disease. High levels allow plaque to build up in your arteries. Levels less than 100 mg/dL (2.6 mmol/L) are considered optimal.

Triglycerides also contribute to heart disease in some people. Levels above 199 mg/dL (2.2 mmol/L) are considered high and may require treatment.

Factors such as heredity, certain drugs and diets high in saturated fat, can lead to unhealthy elevations in lipid levels. Large amounts of carbohydrates or alcohol may also lead to high lipid levels.

According to the American Heart Association, 106.7 million Americans over the age of 20 have a total cholesterol of 200 mg/dL (5.2 mmol/L) or higher. Certain diseases such as diabetes mellitus, hypothyroidism, or the nephotic syndrome can be associated with elevated lipid levels.

What are the risk factors for lipid disorders?

What are the symptoms of lipid disorders?

How are lipid disorders diagnosed?

What are the treatments for lipid disorders?

Are there screening tests for lipid disorders?

How can I reduce my risk of lipid disorders?

What questions should I ask my doctor?

Where can I get more information about lipid disorders?

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

Textbook of Primary Care Medicine.3rd ed. Mosby, Inc; 2001.

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

Lipid disorders usually do not cause symptoms.

In extreme cases, the following signs or symptoms may be found by history or physical exam:

• Fatty deposits in the skin or tendons caused by very high levels of lipids in the blood
• Pain, enlargement, or swelling (inflammation) of abdominal organs such as the liver, spleen, or pancreas due to extremely high levels of triglycerides in the blood
• Changes in the blood vessels of the eye, caused by elevated lipids

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Guidelines Clearinghouse website. Available at: http://www.guideline.gov/ .

A risk factor is something that increases your chances of getting a disease or condition.

Although a person with specific risk factors is at increased risk, anyone can develop a lipid disorder. Having one or more of the risk factors listed below does not necessarily mean that you will get a lipid disorder. But if you do have any of these specific risk factors, you should talk with your doctor about what you can do to reduce your increased risk of developing a lipid disorder.

Risk factors for lipid disorders include the following:

Specific Lifestyle Factors

A diet high in saturated fat, transfat, and cholesterol—Eating food high in saturated fat, transfat, and cholesterol increases cholesterol levels. However, dietary cholesterol does not have as strong an effect on blood cholesterol levels as saturated and transfats.

Physical inactivity—Moderate to intense exercise done on a regular basis helps decrease LDL (bad) cholesterol, while increasing HDL (good) cholesterol, the type that helps prevent heart disease. Get clearance from your doctor before starting an exercise program because people with hyperlipidemia may already have hardening of the arteries or heart disease, which increases the risk of a heart attack or death while exercising.

Smoking—Smoking lowers the amount of HDL, the healthy type of cholesterol, in the blood.

Alcohol intake—While moderate amounts of alcohol can raise the healthy HDL cholesterol, alcohol can also raise unhealthy triglyceride levels. Ask your doctor whether or not moderate alcohol intake is advisable in your situation.

Medical Conditions

Overweight and obesity—Being overweight causes cholesterol levels to rise.

Hypothyroidism—An underactive thyroid can lead to increased triglyceride and cholesterol levels.

Diabetes mellitus—Diabetes is associated with elevated triglyceride levels.

Liver disease—Having liver disease can raise cholesterol levels.

Kidney disease—Some kidney illnesses, called “nephrotic syndrome,” are associated with elevated cholesterol and triglyceride levels

Certain medications—Many medications, including some antihypertensives, oral contraceptives, and steroids, can alter cholesterol levels. Ask your doctor if any of the medications you take could be causing your cholesterol levels to rise.

Age

Advancing age—Cholesterol levels tend to increase with age due to a number of factors. In women, LDL levels often increase after menopause because of changing hormone levels.

Genetic Factors

Family history of lipid disorders—Certain types of high cholesterol are inherited.

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

Lipid disorders are diagnosed with blood tests that measure the level of cholesterol and triglyceride in the blood.

Blood Tests

Cholesterol levels are checked with a blood test. A small blood sample is taken from a vein in your arm. You may need to fast for several hours, usually overnight, before your blood is taken. The test measures levels of:

• Total cholesterol
• LDL (bad) cholesterol
• HDL (good) cholesterol
• Triglycerides

The readings are interpreted as follows:

Total Cholesterol

Level

Interpretation

<200 mg/dL (5.2 mmol/L)

Desirable

200-239 mg/dL (5.2-6.1 mmol/L)

Borderline high

240 mg/dL (6.2 mmol/L) and above

High

LDL Cholesterol

Level

Interpretation

less than 100 mg/dL (2.6 mmol/L)

Optimal

100-129 mg/dL (2.6-3.3 mmol/L)

Near optimal/above optimal

130-159 mg/dL (3.4-4.0 mmol/L)

Borderline high

160-189 mg/dL (4.1-4.8 mmol/L)

High

>190 mg/dL (4.9 mmol/L) and above

Very high

HDL Cholesterol

Level

Interpretation

60 mg/dL (1.6 mmol/L) and above

Protective against heart disease

less than 40 mg/dL (1.0 mmol/L)

A major heart disease risk factor

Triglycerides

Level

Interpretation

less than 150 mg/dL (1.7 mmol/L)

Normal

150-199 mg/dL (1.7-2.2 mmol/L)

Borderline high

200-499 mg/dL (2.3-5.6 mmol/L)

High

500 mg/dL (5.7 mmol/L) and above

Very high

mg/dL = milligrams per deciliter of blood (mmol/L= millimoles per liter of blood)

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

Screening Tests

Blood tests—Cholesterol levels are checked with a blood test. A blood sample is taken from a vein in your arm. You may need to fast for several hours before your blood is taken. The test measures levels of:

• Total cholesterol
• LDL (bad) cholesterol
• HDL (good) cholesterol
• Triglycerides
• Cholesterol/HDL ratio (should be less than 5)

Screening Guidelines

The National Cholesterol Education Program recommends screening for lipid disorders at least once every five years starting at age 20. More frequent or earlier testing may be recommended if you have a family history of elevated lipid levels or other risk factors or conditions known to increase lipid levels, or if your doctor finds a complication that could have resulted from elevated lipid levels.

There are several lifestyle modifications that can lower your risk of developing a lipid disorder. They are:

• Eat a diet low in saturated and transfat and cholesterol.
• Exercise regularly.
• Lose weight if you are overweight.
• Drink alcohol only in moderation.
• Stop Smoking.

Eat a Diet Low in Saturated and TransFat and Cholesterol

A diet low in saturated and transfat and cholesterol and rich in whole grains, fruits, and vegetables will help lower cholesterol levels. Follow the meal plan recommended by your doctor, or ask for a referral to a registered dietitian who can design an eating plan for you.

General guidelines include:

• Limit calories from saturated fat to fewer than 7% of your total calorie intake and cholesterol to less than 200 mg per day.
• Eat five or more servings of fruits and vegetables per day, and six or more servings of whole grains.
• To decrease triglyceride levels, eat cold-water fish (or fish oil supplements) that are high in omega-3 fatty acids, and limit excess carbohydrates.

Exercise Regularly

Exercise can help decrease LDL and increase HDL cholesterol levels. Choose exercises you enjoy and will make a regular part of your day. Strive to maintain an exercise program that keeps you fit and at a healthful weight. For most people, this could include walking or participating in another aerobic activity for 30 minutes every day. But check with your doctor before starting any new exercise program; people with hyperlipidemia may already have hardening of the arteries or heart disease, which increase the risk of a heart attack or death while exercising.

Lose Weight if You are Overweight

Follow the dietary and exercise plan recommended by your doctor. To lose weight, consume fewer calories than you expend. To maintain a healthful weight, eat an equal number of calories to those you use.

Drink Alcohol Only in Moderation

Alcohol can raise triglyceride levels. Moderation means one or fewer alcoholic beverages per day for women and two or fewer for men. One drink equals 12 ounces of beer or four ounces of wine or one ounce of 100-proof spirits.

Stop Smoking

Smoking lowers HDL (good cholesterol) levels. If you are a smoking, participating in a smoking cessation program or using other aids to stop smoking can improve your overall cholesterol picture.

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with lipid disorders. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

• Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
• Write out your questions ahead of time, so you don't forget them.
• Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
• Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Doctor

About Lipid Disorders

• What is my total cholesterol?

• What are my LDL (“bad” cholesterol), HDL (“good” cholesterol), and triglyceride levels?

• What is my ratio of HDL ("good") cholesterol to total cholesterol? What does this mean?

• Do I need medication at this time?

About Your Risk of Developing Lipid Disorders

• Based on my medical history, lifestyle, and family background, am I at risk for a lipid disorder?

• How do I best prevent a lipid disorder?

About Treatment Options

• What medications are available to help me?

• What are the benefits/side effects of these medications?
• Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions?

• What should I do if I forget to take a dose?

• Will I need to take these medications indefinitely?

• Should I take fish oil supplements and/or niacin?

About Lifestyle Changes

• Should I engage in exercise?

• What type of exercise is best?
• How much should I be exercising?
• How do I get started with an exercise program?

• Are there dietary changes I should make? How do I go about it?

• Can you refer me to a registered dietitian?

• Should I stop drinking alcohol?

• How can I find help to quit smoking?

• Do I need to lose weight? If so, how much? Any suggestions on going about it?

• If I change my lifestyle habits, will I still need to take medication?

About Treatment Goals

• At what level do you want me to maintain my cholesterol and triglycerides?

• How will my lipid levels affect my risk for heart disease?

• How will I know if my cholesterol and triglycerides are staying within healthy limits?

• How often will you monitor my lipid levels?