Cholesterol is the fatty substance found in the body and they come in different forms based on density. Cholesterol facilitates some of the vital functions in the body such as hormone formation, cell structure and also digestion. However, the estimation of cholesterol ratio in an individual determines a person’s risk of heart disease. Cholesterol ratio is often measured by taking the good cholesterol – high density lipoprotein ratio and bad cholesterol low density lipoprotein ratio. In order to calculate the total cholesterol level, the value of good cholesterol is divided by the total cholesterol. For treatment purposes, it is important that the values pertaining to good cholesterol(HDL) and bad cholesterol (LDL) are measured.
Our body transports fats(lipids) and water based blood within a single circulatory system. It uses a combination of fats with protein to form water soluble packages called as lipoproteins so that essential fatty nutrients can be transported in the blood and also that fatty waste products can be carried away from body tissues. Lipoproteins are a complex mixture of triglycerides, cholesterol, phospholipids and special proteins. There are five different sizes of these chemical packages with each holding four distinct chemicals in it. Ultracentrifuge will split blood serum into different layers based on density in a test. They are:
- High Density Lipoproteins (HDL): HDL are made in the intestines and the liver. HDLs consist of about 50% protein and 19% cholesterol. They help to remove cholesterol from artery walls. This is why HDLs are addressed as good cholesterol.
- Low Density Lipoproteins (LDL)
LDL carry cholesterol from the liver to other parts of body.They contain about 50% cholesterol. Extra LDLs are absorbed by the liver and excreted into the bile. LDL particles are involved in the formation of plaques in the walls of the coronary arteries. This is why LDL is addressed as bad cholesterol.
- Intermediate Density Lipoproteins (IDL): IDLs are temporary lipoproteins containing about 30% cholesterol
that are converted in the liver to low density lipoproteins (LDLs).
- Very Low Density Lipoproteins (VLDL): These lipoproteins carry mostly Triglycerides, but they also contain
16–22% cholesterol. VLDLs are made in the liver and eventually become IDL particles after they have lost their Triglyceride content.
- Chylomicrons Found in the blood after eating fatty food. They contain about 7% cholesterol. Chylomicrons
transport fats and cholesterol from the intestine into the liver, then finally into the bloodstream. They are metabolized
in the process of carrying food energy to muscle and fat cells.
Good cholesterol / High density lipoproteins
High density lipoproteins play a very significant role in the cleaning up excess cholesterol present in the blood vessels to prevent plaque formation thus acting as effective scavengers. The excess cholesterol is transported to the liver for breakdown and excretion. The levels of HDL in the blood determine the intensity of cleaning process of the blood vessels to prevent atherosclerosis leading to coronary artery disease. The level of cholesterol is measured by milligrams per deciliter of the blood. The normal range for HDL in men and women is 60mg/dl or above. Any value below these levels indicates that the individual is susceptible heart disease. Hence the concentration of HDL is inversely related to cardiovascular disease. HDL also pays an important role in lipoprotein metabolism in donating proteins such as Apo c2, Apo E and VLDL.
Increasing good cholesterol in the body
HDL concentrations increase in the body depends on the lifestyle of an individual. Avoiding smoking can effectively raise the levels of HDL in the body. This accounts for 10 percent rise in the HDL level. Obesity is a major cause for cardiovascular disease and many other associated diseases. Losing excess weight in the body can yield in a gradual increase of HDL levels. Exercises pertaining to cardiac activity such as running, brisk walking, swimming, aerobics can enhance the levels of HDL significantly. Alcohol consumption should be limited to moderate. Choosing the right kind of fats in the diet enables increase in good cholesterol levels. Avoiding foods containing saturated and trans fats is advisable. These fats tend to increase the low density lipoproteins which damage the blood vessels. Fats which contain polyunsaturated and mono unsaturated fatty acids are safe and they increase the level of HDL in the body. Foods containing these fatty acids include olives, peanuts, canola, fish etc. These fatty acids improve the anti-inflammatory action of the HDL.
In addition to changes in lifestyle, medications can also help improve the level of HDL in the body subsequently lowering the LDL levels. Therapeutics such as niacin in association with statins and cholestyramine increase the level of HDL. Statins block substances in the liver which makes cholesterol. They also reabsorb excess cholesterol in the artery walls. These drugs are often used in people who have a history of cardiovascular disease. In addition, fibrates such as fenofibrate and gemfibrozil enhance the HDL level.
Statins are medications that are prescribed to lower high levels of cholesterol. This is done by inhibiting enzyme HMG-CoA reductase; critical to cholesterol production in the liver. While cholesterol comes from diet, it is also manufactured internally in the liver. Since elevated cholesterol is indicated in cardiovascular disease, statins are prescribed for controlling cholesterol levels. In addition to inhibiting cholesterol synthesis, statins play a role in improving endothelial function, maintaining plaque stability and preventing the formation of thrombus.
The typical side-effect of statin is muscle pain, soreness and weakness. Some amount of liver damage might be noticed since it increases the production of certain enzymes. Some might notice nausea, diarrhea or constipation. Many individuals with heart diseases or high cholesterol are looking to switch to natural alternatives to statins or natural statins as they are widely known, to protect themselves from the potential side effects of statins. Foods containing natural statins are fermented soy products, flax seed, fish oil, fibrous grains like oats and barley, fibrous vegetables like beans and carrots, fibrous fruits like apples, avocados and berries.
Dyslipidemia indicates the presence of increased cholesterol in the blood. In general the cholesterol in the body is categorized as good and bad forms, thus referring to its functionality. Good cholesterol also known as high density lipoproteins are required for the body to carry out regular metabolic activities. Estimation of triglyceride levels in the blood serves as a key factor in identifying the amount of disordered fats in the body or dyslipidemia. Dyslipidemia is one of the important causes for the onset of coronary artery disease.
Clinical evaluations of blood cholesterol levels
Clinical presentation of blood cholesterol levels aids estimation of the onset of conditions such as dyslipidemia which leads to cardio vascular disease. Blood cholesterol determination includes the estimation of high density lipoproteins, triglycerides and low density lipoproteins. Values in the case of dyslipidemia contain increased total cholesterol levels i.e. high LDL levels and decreased HDL levels. These levels are checked on fasting for at least 10 hours. Clinical interventions are recommended in the treatment of dyslipidemia to understand the possibility of cardio vascular disease in a patient and to differentiate the primary and secondary categories of this disease.
Diabetes and dyslipidemia
Type 2 diabetes is an underlying medical condition in which dyslipidemia is often noticed. It is measured by the lipid profile analysis. Insulin resistance is the predominant cause of low serum HDL. Insulin resistance promotes another condition called hypertriglyceridemia. This eventually leads to the increase of LDL or low density lipoproteins in the blood which can initiate the onset of atherosclerosis. Patients suffering diabetes with increased values of LDL and VLDL fall under the risk group for coronary artery disease. In addition to this, the metabolism of lipids is directly associated with the release of thyroid hormone. In patients with diabetes and hypothyroidism, the chance of cardiovascular disease is imminent.
Dyslipidemia can occur because of various factors. Most of them are induced by altered lifestyle patterns affecting the metabolism of a person. Obesity is the predominant cause of cardiovascular disease which is directly associated with the presence of dyslipidemia in the person. Symptoms associated are lethargy, gasping and difficulty in participating in any kind of physical activity. Alcohol consumption is also a major cause for the onset of dyslipidemia as it is related to the damage caused to the liver which produces major enzymes for lipid metabolism and fat emulsification processes. Other caused include Cushing's syndrome, Polycystic ovarian disease and liver cirrhosis.
Dyslipidemia is a condition which is treated with effective counseling about healthy lifestyle choices. Eating right and handling stressful factors can subsequently act on the regulation of metabolism. Patients are advised to exercise regularly to prevent the onset of atherosclerosis caused because of dyslipidemia.