dyslipidemia

Relation between dyslipidemia (increased fat in blood) and cardiovascular diseases (diseases of heart arteries, the brain and legs)

Nearly all large studies point to very close relation between increased value of cholesterol and LDL and the occurrence of atherosclerosis of blood vessels of the heart, brain and legs. This relation is so convincing that the increase of cholesterol from 2 - 2,5 g/l to 2,5 do 3 g/l increases the risk of the occurrence of atherosclerosis of blood vessels generally, and of the heart particularly, nearly by 3 times. Inclination toward atherosclerosis is less evident with women, especially on legs and brain arteries. The following table shows normal values of different types of fats in blood.

FAT TYPE	NORMAL VALUES
Cholesterol	≤ 2 g/l
Triglycerides	≤1,25 g/l
ApoB	≤ 1 g/l
LDL	≤ 1,20 g/l
APoAI	≥ 1,20 g/l
HDL	≥ 0,45 g/l
THE LEVEL OF NORMAL VALUES OF FATS IN BLOOD

Values of cholesterol in blood are a good indicator of the stage of damage caused by atherosclerosis. The following table shows the relation of cholesterol in blood and coincidence of death by infarct of the heart muscle.

RISK OF CORONARY DISEASE
Cholesterolemia	Incidence of heart death by infarct of myocardium in ‰	Corresponding risk
< 1,94	42,3	1
1,94 do 2,18	58,7	1,4
2,18 do 2,39	87,4	2,1
2,18 do 2,39	110,0	2,6
> 2,7	154,3	3,7

C L A S S I F I C A T I O N HYPERLIPOPROTEINEMIA according to Frédricksonu
I	Hypertrygliceridemia exogenous	TG	Hylomikrines	AIAII	Upper layer creamy Serum clear
			HDL, VLDL, LDL	B
II A	Hypercholesterolemia Essentialis (homozygote,heterozygote)	Cholesterol total	LDL	B	Serum clear
II B	Hyperlipoproteinemia mixta	Chol. total et TG	VLDL, LDL	A	Serum turbid
				B
				cII cIII
III		Chol. total I TG	IDL, LDL	CE	Serum less turbid
				E3≠0
IV	Hypertrygliceridemia exogenous	TG I Chol total	VLDL	cII cIII	Serum less turbid
V	Hypertrygliceridemia high	TG	VLDL, Chilomicroni	cII cIII	Upper layer creamy Serum clear

Plan, the basis of treatment of increased fat values (LDL) in blood

The increased LDL in the circulation is very harmful (it can be compared with death hazard) because it transforms monocytes , on the surface of blood vessels, into macrophages.

Large studies (mostly) about primary prevention (such as Woscops with pravastatine, HPS with simvastatine) have shown justification and success in the prevention of the atherosclerosis process, because of LDL cholesterol decrease from 25 to 35%, together with the coronary risk by approximately 25 to 35%, either in primary or in secondary prevention.

The following table shows the European consensus (opinion) regarding the treatment of dyslipidemia.

CONSEILS POUR LE TRAITEMEMT DES DYSLIPIDEMIS CONSENSUS EUROPEEN
A	Cholesterol between 2 i 2,5 g Triglycerides<2g	State precisely the risk factor: Heredity , PKP, smoking, Diabetes, Sex, Younger age, HDL<0,35	Hypo caloric and dietary regime. Correction of other risk factors.
B	Cholesterol between 2,5 and 3 g Triglycerides 2g	State precisely the risk factor: Other same as for type A	Hypo caloric low fat regime. Treatment of lipemia if the nutrition regime fails.
C	Cholesterol<2 g Triglycerides between 2 and 5 g	Search for the cause of triglyceridemia: Obesity, alcohol, diuretics, Beta blocators, estrogen, diabetes	Hypo caloric low fat regime. Treat the cause. Fat control.
D	Cholesterol between 2 and 3 g Triglycerides between 2 and 5 g	State precisely the risk factor: (same as under A and B ) Search for the cause of hypertriglyceridemia (same as under C)	Hypo caloric low fat regime. Treat the cause Strictly decrease fats if coronary risk is high.
E	Cholesterol › 3g and/or Triglycerides›5g		Hospitalization is preferred or regular consultation and control by corresponding medical specialist.

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