CHOLESTEROL DISORDERS

CHOLESTEROL DISORDERS

Other Names :
Dyslipidemia, hypercholesterolemia, hyperlipidemia, hyperlipoproteinema, hypertriglyceridemia, lipid transport disorders, lipoprotein disorders. (The article focused to ‘hyper', although ‘hypo’ like hypocholesterolemia includes cholesterol disorders).

Prevalence

For example in USA : The following statistics relate to the prevalence of High Cholesterol; 19% of adults aged 20–74 in USA 1994 (US Government Statistics). Prevalence statistics by age group with high cholesterol in the US 1999-2000 (Health United States, 2003, NCHS) :

1. Age group for men : [11% of men aged 20-34], [21.1% of men aged 35-44], [22.9% of men aged 45-54], [16.5% of men aged 55-64], [19.2% of men aged 65-74], [10.1% of men aged over 75].
2. Age group for women : [9.3% of women aged 20-34], [12.8% of women aged 35-44], [23.7% of women aged 45-54], [26.2% of women aged 55-64], [37.4% of women aged 65-74], [27.6% of women aged over 75].

Lipids Abnormality

Abnormal levels of lipids (especially cholesterol) can lead to long-term problems, such as atherosclerosis. Generally, a high total cholesterol level (which includes LDL, HDL, and VLDL cholesterol) or a high level of LDL (the "bad") cholesterol increases the risk of atherosclerosis and thus the risk of heart attack and stroke. However, not all types of cholesterol increase this risk. A high level of HDL (the "good") cholesterol may decrease risk, and conversely, a low level of HDL cholesterol increases risk. The effect of triglyceride levels on the risk of heart attack is less clear-cut. But very high levels of triglycerides (higher than 500 milligrams per deciliter of blood, or mg/dL) can increase the risk of pancreatitis. For people older than 20, levels of total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol after fasting should be measured at least once every 5 years. Collectively, these measurements are called the fasting lipoprotein profile.

High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. It is important to find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it. Cholesterol lowering is important for everyone–younger, middle age, and older adults; women and men; and people with or without heart disease.

Causes

The major cholesterol disorders are primarily hereditary (familial) and therefore genetically determined. Secondary causes can contribute to congenital lipid disorders or can independently account for abnormalities of blood lipid metabolism. Among the secondary causes are the following conditions: Hypothyroidism, biliary cirrhosis, nephrosis, anorexia nervosa and acute intermittent porphyria can cause significant increases in blood cholesterol levels. Diabetes, chronic alcoholism, chronic kidney failure and acute hepatitis can cause significant increase in blood triglyceride levels. However, the most apparent secondary cause of lipid disorders is the high dietary cholesterol and fat content consumed by the American public.

There are drugs that can cause this disorders. The following drug have been reported to cause abnormal increase in cholesterol blood levels: anabolic (malehormonelike) steroid, chenodiol, disopyramide, thyazide diuretics, trimeprazine. The following drugs have been reported to cause abnormal increases in triglyceride blood levels: cortisonelike drugs, estrogens, isotretinoin, oral contraceptives, thiazide diuretics, timolol.

Detection and Evaluation

Adult Treatment Panel (ATP) III recognizes that detection of cholesterol disorders and other coronary heart disease (CHD) risk factors occurs primarily through clinical case finding. Risk factors can be detected and evaluated as part of a person’s work-up for any medical problem. Alternatively, public screening programs can identify risk factors, provided that affected individuals are appropriately referred for physician attention.

The identification of cholesterol disorders in the setting of a medical examination has the advantage that other cardiovascular risk factors—including prior CHD, PVD, stroke, age, gender, family history, cigarette smoking, high blood pressure, diabetes mellitus, obesity, physical inactivity—co-morbidities, and other factors can be assessed and considered prior to treatment. At the time of physician evaluation, the person’s overall risk status is assessed. Thus, detection and evaluation of cholesterol and lipoprotein problems should proceed in parallel with risk assessment for CHD.


Reference:

1. Long JW, The Essential Guide to Prescription Drugs, HarperCollins Publisher, Inc. 1993 Edition, New York, 50-53
2. Salinas CAS, Olaiz G, et all, High prevalence of low HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican nationwide survey Journal of Lipid Research, Vol. 42, 1298-1307, August 2001
3. http://www.wrongdiagnosis.com/c/cholesterol/stats.htm
4. http://www.merck.com/mmhe/sec12/ch157/ch157a.html
5. http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.htm
6. Grundy S.M, Cleeman J.I et al, Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines, NCEP Report, (Circulation. 2004;110:227-239.)
7. NIH, Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), National Cholesterol Education Program National Heart, Lung, and Blood Institute National Institutes of Health NIH Publication No. 02-5215 September 2002