Hyperlipidemia - is an abnormal increase in the content of the various lipoprotein fractions in the circulating blood.The fact of hyperlipidemia in humans is a risk factor for the occurrence of chronic progressive diseases of the heart and blood vessels, aggravating this pathology.In addition, a significant increase in various lipid fractions promotes signs of pancreatitis.
Due to the fact that the vast majority of lipid fractions takes an indirect part in the formation of atheromatous plaques occlusive vascular lumen, this condition eventually leads to trophic disorders in all tissues of the human body, due to the impact of prolonged ischemia.
According to world statistics about a quarter of the population of the planet suffers pathology caused by an increase in plasma lipids, especially cholesterol.In the randomized study proved that men are characterized by increased rates of physiological lipid profile compared to the female.And women have a compensatory increase in lip
Causes of hyperlipidemia
In the process of excessive accumulation of various lipid fractions in the human body, namely in the blood plasma, it affects a large number etipatogeneticheskih factors, some of which are amenable to correction medication and medical methods, while others belong to the category of permanent risk factors.
not modifiable etiopathogenetic factors of signs of hyperlipidemia are:
- sexual identity (men are more predisposed development of signs of some form of hyperlipidemia);
- advanced age of the patient;
- family history about the predisposition to diseases associated with hyperlipidemia.
presence of one or a combination of these factors, the patient is the basis for the application of preventive measures for the prevention of complications arising on a background of prolonged severe hyperlipidemia.
Yet a large group of factors causing the development of hyperlipidemia, comprise modified etiopathogenetic mechanisms, and in most cases is accompanied by the elimination of these causes partial or complete leveling signs of increased lipid levels.This group make up reasons:
- long systematic use of food saturated with low-density lipoproteins and triglycerides;
- overweight, due to the massive development of adipose tissue;
- a complete lack of physical activity;
- uncontrolled hyperglycemia in patients suffering from diabetes for a long time, contributing to severe disorders of the pancreas;
- hormonal disorders with predominant thyroid changes;
- during pregnancy, especially the last trimester, often accompanied by a transient physiological hyperlipidemia, which has severe consequences and in most cases leveled in the early postpartum period;
- lasting systemic administration of some groups of drugs (combined hormonal contraceptives, corticosteroids).
Due to the fact that hyperlipidemia is nothing but a clinical and laboratory syndrome, specific clinical manifestations that distinguish it from other pathologies that do not exist.Clinical signs begin to appear only in the development of signs of atherosclerotic disease and the extent of their occurrence has a clear dependence on the spread and severity of the process.
even against a background of well-being in patients with hyperlipidemia, there is a risk of severe complications of cardiovascular profile.In this regard, all the people who have relatives suffering from any vascular disease, it is recommended routinely evaluated for the content of lipid fractions of blood to exclude hyperlipidemia.
A prerequisite for carrying out laboratory analysis titled "lipidogram" is the preliminary preparation of the patient, which consists in completely excluding meals at least 14 hours before the study.In the period of acute myocardial infarction there are significant changes in lipid profile with high cholesterol, and signs of recurrent myocardial infarction is the predominance of triglycerides in the lipid profile.
lipidogram is the definition of a large number of indicators of various lipid fractions and classification of hyperlipidemia based on the prevalence of various indicators.There is increasing as an isolated one of the fractions, and an increase of a large number of indicators, thereby forming a mixed hyperlipidemia.
Primary or hereditary hyperlipidemia, divided by etiopathogenetic principles of its emergence into five types:
- the first type of hyperlipidemia is now a rare disease, and pathogenic mechanism of its occurrence based on the expressed deficiency of lipase lipoprotein fractions, accompanied by a high content of chylomicrons andplasma triglycerides.This form of hyperlipidemia is not related to the development of atherosclerotic changes and more is reflected in the reduction of pancreatic function.Correction of hyperlipidemia is severe restriction of fat intake;
- familial hyperlipidemia second type is caused by the stimulation of the formation of beta-lipoprotein or delayed their destruction, so that the conditions for an excessive accumulation of low-density lipoprotein.Debut hyperlipidemic changes accounted for the children's age, and young period in the majority of patients are already signs of atherosclerotic heart disease.About 30% of cases of familial hyperlipidemia accompanied by the development of signs of acute circulatory disorders in the coronary and cerebral arteries of large;
- the third type of hyperlipidemia is extremely rare and is caused by the appearance of its signs of abnormal blood levels of lipoprotein.Lipidogram this category of patients undergoing major changes with a predominance of very low density lipoproteins, which are short-term deadlines provoke the formation of atherosclerotic plaques;
- hyperlipidemia fourth type, which is based on part of the high content of triglycerides in the blood plasma, is the most common form of the lipid metabolism.Risk for the disease are persons of middle age, suffering from dysfunction of the pancreas and chronic changes in vascular caliber;
- pathogenetic mechanisms of the fifth type of hyperlipidemia based on abuse of process failure and excretion of triglycerides, arriving with food in excess.The debut of the disease accounts for adolescence and manifests itself in the dysfunction of the pancreas, followed by the development of signs of pancreatitis.
Therapeutic activities under any form of hyperlipidemia are primarily aimed at correcting the modifiable risk factors with non-drug techniques, as well as the manifestations of hyperlipidemia drug elimination and prevention of possible complications.
great importance in leveling signs of hyperlipidemia is lifestyle modification and correction of eating behavior.Lifestyle modification is nothing more than the removal of factors contributing to the development and progression of disease.
Prior to the use of specific medicinal drugs aimed at reducing the patient's lipid profile should be persuaded of the need to comply with certain diets.Lipid-lowering diet for hyperlipidemia greatly reduces the risk of complications of cardiovascular profile.
Drug correction of hyperlipidemic conditions applied for the treatment of patients with atherosclerotic manifestations, and in asymptomatic course of the disease.Drugs used for the purpose of lipid-lowering therapy, aimed at immediate decline of cholesterol, mainly due to the low density lipoprotein (bile acid sequestrants and statins).The field of application of this group of drugs is a family type of hyperlipidemia.
To correct rate increase of triglycerides and very low density lipoproteins medication used drugs of fibrates and nicotinic acid derivatives.These medicaments find their use in all forms of hyperlipidemia as contribute to the performance of high density lipoproteins, are directly involved in the prevention of atherosclerosis.
Statins are synthetic antibacterial and microbial origin, whose action is directed to the inhibition of the enzyme catalyzes the process of biosynthesis of cholesterol in the liver parenchyma.During the first week of statins observed the establishment of stable concentrations of the active substance in the blood, but the maximum positive effect of the drug in this group there is no earlier than 6 weeks.When you assign a patient to correct statin lipid profile should take into account that after the drug is marked increase in indicators of cholesterol and its fractions.
In most cases, drugs in this group of drug well tolerated by patients, but there are a number of conditions that are absolute contraindications to their use (infectious diseases in the acute stage, liver parenchyma lesions, accompanied by increase in transaminases).Atorvastatin is most often applied in the minimum daily dosage of 20 mg and gradually increasing the dose to 80 mg of systematic control indicators lipidogram and transaminases.
In situations where the patient has contraindications to the use of statins, or as an additional hyperlipidemic therapy applied preparations of bile acid sequestrants (Colestipol in therapeutic daily dosage of 16 g, p.o.).Drugs in this group do not apply in the case of pronounced increase triglyceride levels, as well as the manifestations of colitis with a tendency to constipation.
Elevated levels of triglycerides in the plasma, lends itself well to correction by the use of fibrates (bezafibrate at a daily dose of 1000 mg) that target the stimulation of the activity of lipoprotein lipase and enhancing fatty acid oxidation in the liver parenchyma.The field of application of fibrates is diagnosed third type of hyperlipidemia.
nicotinic acid is recommended to apply, if necessary, the decrease of triglycerides and total cholesterol.The maximum daily dosage of this group of drugs is 3 The data drugs are not widely used in the treatment of patients with hyperlipidemia have been accompanied by the development of the reception of a number of adverse reactions in the form of redness of the skin of the upper half of the trunk and dyspeptic disorders.