The “lipid profile” is a popular component of master health check ups. Almost 40 per cent of Indians have elevated lipids, placing them at high risk for catastrophic “heart attacks” and strokes.
There is no ideal age for the first evaluation. Elevated levels have been found in children as young as two if there is a history of adults in the family having elevated lipids or early heart attacks. Genetic studies have consistently shown changes in the Apolipoprotein E (APOE) locus in affected families. But for this gene to express itself, environmental factors like diet, obesity and inactivity also play a part.
If there is no such family history, lipids should be evaluated for the first time at the age of 20. If the results are “desirable”, the next reading can be taken after five years. In an older person (over 45 in men and 55 in women) the values need to be checked every year.
The blood should be taken after a nine-hour fast (water can be consumed). There should be no fever, infection, inflammation or pregnancy as these can alter the values.
Everyone has fat deposits under the skin, where it serves as insulation against heat and cold. Cholesterol is a fat that is produced by the liver and is essential for normal metabolism. It is not soluble in blood, it is transported through the body by LDL (low density lipoproteins), HDL (high density lipoproteins) and VLDL (very low density lipoproteins). Of these HDL is a “good” lipid as it transports excess cholesterol to the liver for excretion. VLDL and LDL transport cholesterol from the liver back into the blood.
As long as blood cholesterol remains in the normal range, the blood circulates freely. When levels are elevated, it precipitates in the blood vessels, forming obstructive deposits called plaques. This eventually leads to high blood pressure, heart attacks and strokes.
TGL or triglycerides are different from cholesterol. They are derived from food when the calorie intake is greater than the requirement. It combines with cholesterol and gets deposited in the blood vessels.
A person with elevated lipids may develop a yellow deposit of cholesterol under the skin, usually around the eyelids. They may also have a crease on the earlobes.
A fat deposit (lipoma) can appear as a painless mobile lump just under the skin anywhere in the body. When multiple, it is a hereditary condition called multiple lipomatosis. These are not markers for elevated lipids. The lumps are not cancerous but may be cosmetically unacceptable. They do not respond to the lipid lowering medications and need to be surgically removed.
An elevated lipid profile can often be reversed by changes in lifestyle. Quit smoking immediately and drink in moderation only — two drinks a day for men and one for women. The much publicised cardio protective actions of alcohol are outweighed by the other problems of regular drinking.
Try to achieve ideal body weight and bring down the BMI (body mass index, which is found by dividing the weight by the height in metre squared) to 23. This can only be achieved with a combination of diet and exercise. Try to stop snacking, especially on fried items and “ready to eat” snacks. Increase the consumption of fruits and vegetables to 4-6 helpings a day. Walnuts, almonds and fish are rich in protective omega -3 fatty acids and Pufa (poly unsaturated fatty acids). Oats contains dietary fibre. Lower oil consumption to 300ml per month per family member. Try to use olive oil. If that is not practical or feasible, use a mixture of equal quantities of rice bran oil, sesame oil, mustard oil and groundnut oil.
Exercise aerobically (walking, running, jogging or swimming) for 60 minutes a day. This need not be done at one stretch but can be split into as many as six 10-minute sessions.
If lipids are still elevated after 3-6 months despite these interventions, speak to your physician about regular medication.
The “statin” group of drugs are very effective. They lower cholesterol, prevent its deposition and stabilise the plaques in the blood vessels. They can be combined with other drugs like ezetimibe (which limit the absorption of cholesterol), or bile acid binding resins, or niacin or fibrates. Natural supplements of fish oil or pure omega-3 fatty acid capsules also help. Lipid lowering medications are usually well tolerated and very effective.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org