What is a lipid clinic?
A lipid clinic focuses on elevated cholesterol, triglycerides and other risk factors which can lead to accelerated atherosclerosis (narrowing of blood vessels). This increases the chances of premature cardiac events or heart attacks and strokes. The management of deranged cholesterol is challenging and hence this clinic is required.
Why visit a lipid clinic?
Cardiovascular diseases are the leading cause of mortality amongst Indians and nearly 79% of Indians have skewed lipids as per Indian Council of Medical Research. Evidence says that deranged lipids is the leading risk factor for heart attacks and strokes.
What do the terms GOOD AND BAD cholesterol mean?
LDL-c (Low density lipoprotein - cholesterol) is the ‘culprit’ that causes the arteries to narrow reducing blood circulation and is known as Bad Cholesterol.
HDL-c (High density lipoprotein - cholesterol) is the Good Cholesterol because it has the ability to remove excess cholesterol from the peripheral tissues and it improves health.
What are the high risk problems that are associated with elevated cholesterol?
- Heart disease & brain strokes
- Diabetes
- Hypertension
- Hypothyroidism
- Metabolic syndrome and obesity
- Family history of strokes or cardiac problems
- Inflammatory joint problems, gout and HIV disease
- Certain medications
- Alcohol
- Smoking
- Lifestyles
Heart disease and brain stroke
Excess LDL cholesterol in your blood starts piling in the walls of the arteries. Over time, this buildup causes “hardening of the arteries” and formation of plaque so that arteries become narrowed and blood flow through them slows down. This process of formation of plaque is called atherosclerosis. The LDL-c in the plaque gets oxidised. When the burden of LDL-c in the plaque rises, it ruptures. This attracts blood cells like platelets to this site to patch up the damage leading to a thrombus (blood clot) formation. A complete obstruction of an artery of the heart or brain can cause a heart attack or brain stroke/ paralysis.
Diabetes
Diabetes is associated with “diabetic dyslipidemia” which is characterised by a triad of low HDL, elevated small-dense LDL and high triglycerides. Due to the small size of LDL-c particles in diabetes, it is easier for them to penetrate the lining of arteries leading to plaque formation eventually.
Hypertension
Rise in blood pressure is a lifestyle related disease and associated with elevated LDL-c and triglycerides. When the arteries become hardened and narrowed with cholesterol plaque deposits and calcium (atherosclerosis), the heart needs to work much harder to pump blood through them. Hence, blood pressure becomes high.
Hypothyroidism
The thyroid gland takes care of the metabolism. When thyroid hormone levels are low (hypothyroidism), the body cannot remove LDL cholesterol as efficiently. LDL cholesterol can then build up in your blood. Elevated thyroid levels has an opposite effect.
Metabolic syndrome and obesity
Metabolic syndrome is diagnosed when a person has any 3 of the following features -
- Abdominal Obesity (Waist size - Males > 90cm, Females > 80 cm)
- Blood glucose ≥ 100 gm/dl
- BP ≥ 130 / ≥ 85
- Triglycerides ≥ 150 mg/dl
- Low HDL-c (Males < 40 mg/dl, Females < 50 mg/dl)
Obesity is defined as high Body Mass Index (BMI) which is calculated based on the height and weight of an individual.
- Normal Body Mass Index (BMI) is 18.0-22.9 kg/m2
- Overweight is defined as BMI between 23 - 24.9 kg/m2
- Obesity is defined as BMI over 25 kg/m2
Obesity and metabolic syndrome increase cardiovascular risk through risk factors such as increased plasma triglycerides, high LDL cholesterol, low HDL cholesterol, elevated blood glucose & insulin levels and high blood pressure. There is overproduction by the liver of VLDL-c and LDL-c. All these lipid abnormalities are typical features of the metabolic syndrome and may be associated with inflammation which in part may originate in the adipose tissue itself and directly affect the lining of blood vessels. An important link between obesity, the metabolic syndrome and deranged cholesterol seems to be the development of insulin resistance in fat cells and muscles.
Family history of strokes or cardiac problems
There are some inherited conditions which cause elevated LDL cholesterol values like Familial Hypercholesterolemia (FH). In this case, the family history of high cholesterol and heart attacks or strokes amongst relatives. FH is an under diagnosed and under treated condition in India. Patients may present with yellowish deposits in the eyelids (Xanthelasmas) or bumps (Xanthomas) over the body.
Inflammatory joint problems, gout and HIV disease
All these conditions are associated with inflammation and cause damage to the blood vessels leading to atherosclerosis.
Certain medications
Certain BP medications like diuretics and beta blockers, corticosteroids, antipsychotics, hormones and HIV medications can bring about rise in cholesterol or triglycerides.
Alcohol
Most of the benefits of moderate quantities of alcohol applies to the western population. Evidence proves that alcohol use is not protective in Indian men. Rather, it is associated with possible harm. Hence, alcohol intake even in moderation should be avoided by Indians.
Smoking
Tobacco increases the detrimental effects of LDL-c, lowers HDL-c and is associated with inflammation leading to atherosclerosis, blood clot formation and risk of heart attacks or strokes.
Lifestyles
Eating a diet high in saturated fat, trans fats and sugar also elevates LDL-c levels. Regular exercise raises good HDL cholesterol and lowers triglycerides, which is a type of fat that is a risk factor for heart disease. It also helps in maintaining a healthy weight.