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Dyslipidemia definition, risks, symptoms, prevention, consultation

Dyslipidemia: definition

Dyslipidemia are abnormal lipids (fats) in the blood. By definition these are figures: assays of biological indicators.

These indicators are part of lipid cardiovascular risk factors. They relate to different forms of blood cholesterol and triglycerides. Cholesterol is not soluble, it is transported as LDL (Low Density Lipoprotein) or bad cholesterol, and HDL-cholesterol (High Density Lipoprotein) or good cholesterol. Their transporter proteins are Apolipoprotein B for LDL-cholesterol and apolipoprotein A1 in HDL-cholesterol.

Deficits in blood lipids are rare in industrialized West, there is little talk of hypolipidemia (or hypolipemia). However, excesses are legion. Hyperlipidemia (or hyperlipidemia) refers to the overall excess blood lipids. One distinguishes excess cholesterol, hypercholesterolemia, of excess triglycerides, hypertriglyceridemia. The different varieties of hyperlipidemia make the rather complex domain there is a medical specialty Lipidology.

Dyslipidemia: risks and challenges

Dyslipidemia is a cardiovascular risk factor, especially the bad cholesterol (LDL-cholesterol). Other risk factors are hypertension, smoking, diabetes, alcohol, obesity (especially abdominal), age, sedentary lifestyle, hormonal contraception and hormone therapy for menopause. The latest recommendations of the European Society of Cardiology (ESC, 2011) add to this already long list HDL-cholesterol in insufficient quantities.

The combination of these factors quickly increases the overall cardiovascular risk, determines the management of dyslipidemia. It can be calculated by using tables to several parameters, refined according to the national level of risk in Europe (SCORE tables).

Overall cardiovascular risk is often responsible for fatal diseases always disabling: atheroma (clogged arteries), aggravation of hypertension, coronary heart disease (angina, myocardial infarction), stroke ( AVC), arteritis of the lower limbs ...

Dyslipidemia are silent for the patient for many years, but present. The proportion of pure hypocholesterolemias (without elevated triglycerides) population would be 30% from Ferrieres et al. (Archives of Diseases of the heart and vessels, 2005).

Dyslipidemia: running

Triglycerides are the reflection of the feed, but not cholesterol depends to 25%. Three quarters of blood cholesterol is produced by the body (liver) mainly under the influence of genetic inheritance. Drugs, endocrine diseases such as hypothyroidism or diabetes also have an impact on blood lipids.

LDL cholesterol is a soluble lipoprotein that transports cholesterol from the liver, where it is produced continuously, bodies in need. These requirements are important because the cell membranes of many hormones are manufactured based cholesterol. Cholesterol is an essential molecule.

LDL cholesterol is called "bad cholesterol" because it is not consumed rapidly by the tissue is deposited in the arteries. There form atherosclerotic plaques, rigid, inflammatory, capable of causing local blood coagulation. The clot can block the artery at the site of its formation, or migrate to the butcher elsewhere (frequent phenomenon in stroke).

HDL transports cholesterol in excess cholesterol to the liver organ which degrades the bile salts and the evacuated in the stool. It is essential to clean the excess cholesterol and therefore called "good cholesterol."

Atherosclerosis combines atheroma (plaques LDL) cholesterol and arterial damage of smoking, diabetes, for example. It is a disease due to cardiovascular risk factors and family history.

Dyslipidemia: symptoms

Dyslipidemia have the distinction of being long silent, that is to say not manifest any symptoms. When symptoms occur cardiovascular (myocardial infarction, angina pectoris, arteritis ...), arterial atherosclerosis and cardiac lesions are already significant.

However, a large excess cholesterol is expressed by fatty deposits around the eyes (xanthelasma) or around the iris of the eye (corneal gerontoxon or arc). This applies especially familial hypercholesterolemia due to a particular genetic profile. Family history of cardiovascular disease, particularly those occurring before age 50, justify the consultation for a full assessment.

The silence of dyslipidemia justifies a regular Blood tests of the population. But how often? In the USA, considerable prevalence of obesity in children (almost 30%) did pediatricians recommend a routine blood screening between ages 9 and 11. The blood test is recommended based on specific clinical situations.

Dyslipidemia Prevention

With what should we be confused dyslipidemia?

The diagnosis of dyslipidemia is a biological definition encrypted, which can not be confused with another disease.

However, it is not a disease in itself until you have verified that dyslipidemia is not part of another disease, or that it is a particular genetic profile.

Will it possible prevention of dyslipidemia?

Yes, before any incident prevention (primary prevention) is possible and desirable for a healthy lifestyle, effective but demanding. A Finnish study showed that anti-cholesterol and adequate exercise regime fell cardiovascular mortality by 65% ​​in men. (Progress in Cardiovascular diseases, November 2006).

Weight loss in overweight people lowers blood fats, the sugar and the blood pressure. After a stroke, the lifestyle changes and medication are significantly lower risk of recurrence (secondary prevention).

National campaign to promote good health habits established by the Ministry of Health (National Health NFHP or nutrition program) aimed at reducing cardiovascular risk according to the public health laws passed since 2004.

Dyslipidemia Prepare consultation

When did you consult?

As dyslipidemia are long silent must carry out regular assessments. Screening every five years from age 40 for men (50 years or menopause for women) is usually recommended when there is no other known cardiovascular risk factors that will require the practice earlier. Family history of dyslipidemia warrant early detection, sometimes from childhood.

How to prepare the consultation with the doctor?

Gather family history of cholesterol, triglycerides and cardiovascular disease.
Bring his blood tests with the determination of cholesterol and triglycerides.

Finally, a summary of its power gives valuable insights.

What is the doctor?

He practices a blood test as recommended best practices, in addition to the comprehensive review of the patient, particularly when advancing age. He is looking for an organ by atherosclerosis reached.

The lipid laboratory tests used to assess cardiovascular risk. The controversy over the levy fasting or not was decided by the European Society of Cardiology (Recommendations on dyslipidemia, 2011). Triglycerides should be measured fasting. But total cholesterol, apolipoproteins A1 and B, and HDL-cholesterol can be assayed at any time.

Then the doctor makes the counting of cardiovascular risk factors and place the patient in a European risk tables: SCORE. The European Society of Cardiology has updated in 2011. Cardiovascular risk is expressed in percent, this risk is at least a cardiovascular event within 10 years. Between 1 and 5%, the person is said to moderate risk between 5-10% high risk (high risk), beyond 10% the risk is very high (very high risk).

This explains why we can not set standards for assembly without cardiovascular risk. For a healthy young adult without further risk, total cholesterol should be less than or equal to 2 g / l, greater than or equal to 0.4 g HDL cholesterol / l, less than or equal to 1.5 g triglyceride / l. These values ​​are more severe with the confirmation of the adverse impact of hyperlipidemia on health, and especially as life expectancy is high.

Support depends on the risk

In patients at very high risk, LDL-cholesterol (LDL-C) should ideally be less than 0.7 g / l. If this goal can not be achieved, it must be reduced by at least 50% of the initial value of LDL-C. In patients at high risk, it is an LDL-C less than 1 g / l. In patients at moderate risk, is an LDL-C less than 1.15 g / l.

Various measures are taken by successive additions, or immediately when the whole cardiovascular risk is high or very high. The first is the implementation of SUITABLE lifestyle and dietary measures, the second is the disappearance or reduction of other modifiable risk factors: smoking, obesity, hormonal contraception ...

The treatment of hyperlipidemia by lipid-lowering drugs may be necessary. He never taught the proper treatment of associated diseases: hypertension, metabolic syndrome, diabetes ...

Regular monitoring is essential because it determines the success of follow-up care.

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