Management of Hyperlipidemia

Elevated levels of fatty components in our blood is termed as hyperlipidemia. It is considered as a primary risk factor for coronary heart disease (CHD), stroke and peripheral vascular disease irrespective of the gender of a patient. Hyperlipidemia may complicate the health status in association with the diabetes, hypertension and kidney disease. There exists a strong association between the total cholesterol level and CHD. The cholesterol homeostasis is maintained by the liver and small intestine through very delicate balance of cholesterol input (dietary intake and de-novo synthesis of cholesterol) and elimination by conversion to bile and through fecal excretion. In the liver cells (hepatocytes) low density lipoprotein cholesterol (LDL-C) is produced through the conversion of HMG-Coenzyme-A (HMG-CoA) to mevalonic acid. It is important to note that LDL-C is a bad lipid whereas HDL-C is good. There is need to keep a check on the level of cholesterol in general and LDL-C in particular.

Cardiovascular morbidity and mortality is directly associated with the level of total cholesterol and LDL-C, and inversely with the level of high density lipoprotein cholesterol HDL-C). Cholesterol-enriched and triglyceride-rich lipoproteins, including very low density lipoproteins (VLDL) and intermediate density lipoproteins ((IDL) could also promote atherosclerosis. The elevated level of LDL-C warrants the need of cholesterol lowering therapy, inclusive of life style modification and cholesterol lowering drugs. HMG-CoA reductase inhibitor or statins are the most potent and widely used drugs for treating hypercholesterolemia or hyperlipidemia because of their efficacy in reducing LDL-C to the desired level as recommended by the National Cholesterol Education Program (NCEP). For effective control of hyperlipidemia around 20-55% reduction in the level of LDL-C needs to be achieved by Statins. The hyperlipidemia may be primary (heterozygous familial or non-familial hyperlipidemia) or secondary to some other disorder like renal disease. It has been established now that ezetimibe as monotherapy in association with customized diet, effectively reduces the elevated level of total cholesterol, LDL-C, Apo-B and triglycerides, and increases the level of HDL-C in patients with hypercholesterolemia. Ezetimibe is a selective cholesterol absorption inhibitor and was approved by FDA about 8 years ago. Statins (atorvastatin, lovastatin, pravastatin and simvastatin) are potent, HMG-CoA reductase inhibitors. The combination of ezetimibe and atorvastatin or simvastatin is effective therapy for taming down the elevated levels of total cholesterol and LDL-C in patients with homozygous familial hypercholesterolemia (HoFH). The treatment of hyperlipidemia should be commenced under medical advice and follow-up with biochemical evaluation of lipids in blood.

Important tip: Kill the fat before it kills you.