High Cholesterol (Hyperlipidemia)

Obese patients have high bad-cholesterol levels and low good-cholesterol levels.

High cholesterol (Hyperlipidemia)

Obesity refers to excess amount of fat in the body. Fat deposition occurs when the calorie intake is more than the calories burnt. Obesity can be determined by body mass index (BMI), which is an estimate of body fat using height and weight of a person. BMI of >30 kg/m² is considered obesity.

Hyperlipidemia (aka dyslipidemia) refers to elevated levels of fats, such as cholesterol and triglycerides in the blood. Cholesterol is a waxy, fat-like substance present in the body cells. It is required to make hormones, Vitamin D and help in digestion. Cholesterol is carried by a protein in the body called lipoproteins.

  • Types of fats +

    There are three different types of fats in the body. They are:

    1. Low-density lipoprotein (LDL): It is also known as “bad cholesterol”, as it is responsible for causing accumulation of fat deposits on the inner walls of the arteries (blood vessels that carry oxygenated blood from the heart to different organs). High-density lipoprotein (HDL): It is also known as “good cholesterol”, as it brings excess cholesterol to the liver, which then gets excreted from the body. High HDL cholesterol protects against heart diseases.
    2. Triglycerides: These are the stored fats that are formed when the body converts the unused calories into fats and store them in cells.

    The normal levels of different types of cholesterol are as follows:

    Types of cholesterol Normal levels (mg/dL)
    LDL <100 both in men and women
    HDL In men: 40-50; In women: 50-60
    Triglycerides <150 both in men and women

     

  • Relation between obesity and hyperlipidemia +

    In obese patients, triglycerides and LDL levels are high, whereas, HDL levels are low in the blood. HDL cholesterol carries excess or bad cholesterol from the blood to the liver, from where the excess fat will be eliminated. But, when the HDL levels are decreased, the triglycerides and LDL cholesterol levels become elevated, resulting in hyperlipidemia.

    High triglycerides and LDL levels in the blood gradually lead to the accumulation of plaque (fat deposits) in the blood vessels. This plaque formation weakens and damages the artery and results in the development of heart diseases.

    Obesity, especially abdominal obesity causes insulin resistance and is associated with dyslipidemia, impaired glucose metabolism, and hypertension (high blood pressure). All these conditions may be responsible for developing atherosclerosis, which may further result in the development of diseases related to the heart, kidney, eyes, and brain.

  • Risk factors for hyperlipidemia +

    The factors that increase the risk of dyslipidemia include:

    • Age > 45 years for men and >55 years for women
    • Family history of hyperlipidemia
    • Post-menopausal women
    • Lack of physical activity or exercise
    • Diet including saturated fats and calories
    • Smoking
    • Alcohol consumption

    hyperlipidemia is also found in other conditions, such as kidney disease, polycystic ovarian syndrome (PCOS), diabetes, under-active thyroid, pregnancy, and other inherited conditions. Cholesterol levels can also be altered due to certain medications like birth control pills, diuretics, and depression medicines.

     

  • Management of obesity-associated dyslipidemia +

    Weight loss is the ultimate step to prevent dyslipidemia in obese patients. Reducing weight will not only improve cholesterol levels but also lower blood pressure, improve glucose control, and prevent obesity-related conditions. This can be achieved by following the necessary lifestyle changes, such as:

    • Physical activity: Exercise daily for at least 30 minutes. Doing so will improve the HDL levels and reduces the triglycerides and LDL levels in the blood. Muscle-strengthening exercises are of great help but should be done only when recommended by the doctor. However, overweight patients should engage in low-intensity exercise more frequently and for longer durations.
    • Alcohol and smoking: Avoid consuming alcohol, as it increases the triglyceride levels along with HDL cholesterol in the blood. Smoking increases the lipid levels in the blood, so quitting it would be helpful.
    • Diet: Avoid consuming fatty foods and calorie-rich foods like carbohydrates, canned beverages, and processed foods. Instead, include fiber-rich foods, such as fruits, green vegetables, fish oil, almonds, avocado, whole grains, cereals.
    • Hydration: Drink adequate amounts of water, especially during exercise, which helps in weight loss. Fluid intake helps to balance the abnormal sodium levels caused due to obesity.

    In addition to lifestyle modifications, the doctor will recommend lipid-lowering drugs, which help in lowering the elevated cholesterol levels in the blood. After starting the treatment, follow-up regularly every six months to evaluate the condition.

  • Outlook +

    Dyslipidemia associated with obesity mainly occurs due to high cholesterol levels or excess weight. So, obese people should mainly focus on weight reduction to prevent the risk of dyslipidemia. Making healthy lifestyle changes, such as diet and exercise, and practicing them can help in weight loss. Take the prescribed medications regularly to lower the cholesterol levels in the body. Undergo regular check-up to maintain the levels of LDL cholesterol of <100mg/dl and a triglyceride level of <150mg/dl. Engage in weight loss programs, which help to reduce obesity and improve the quality of life.

     

    References

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705344/

    https://www.hopkinsmedicine.org/digestive_weight_loss_center/conditions/high_cholesterol.html

    https://www.aafp.org/afp/1998/0501/p2192.html#sec-5

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