Dyslipidemia is a disorder of lipid metabolism characterized by elevated levels of total cholesterol, low-density lipoproteins (LDL), triglycerides, and/or reduced levels of high-density lipoproteins (HDL). This condition is a major risk factor for cardiovascular diseases such as ischemic heart disease, myocardial infarction, and stroke.
The management of dyslipidemia is aimed at normalizing blood lipid levels, preventing complications, and improving overall health outcomes.
Causes and clinical features of dyslipidemia
Main causes:
- Genetic factors (familial hypercholesterolemia).
- Unhealthy diet with a high content of saturated fats.
- Overweight and obesity.
- Sedentary lifestyle.
- Chronic diseases such as diabetes mellitus and hypothyroidism.
- Use of certain medications, including hormonal agents or diuretics.
Symptoms of dyslipidemia:
In the early stages, dyslipidemia is often asymptomatic. In more advanced stages, the following signs may occur:
- Xanthomas (lipid deposits in the skin).
- Chest pain (associated with the development of ischemic heart disease).
- Increased fatigue.
- Leg cramps due to impaired peripheral circulation.
Diagnostic methods
Dyslipidemia is diagnosed using a lipid profile (lipid panel), a blood test that evaluates key parameters of lipid metabolism and helps assess cardiovascular risk. The lipid profile includes:
- Total cholesterol level.
- Concentrations of high-density lipoproteins (HDL) and low-density lipoproteins (LDL).
- Triglyceride level.
Special attention is given to lipoprotein(a), Lp(a), a macromolecular complex consisting of LDL and a specific protein—apolipoprotein(a). This parameter is genetically determined and represents an important independent risk factor for atherosclerosis, ischemic heart disease, myocardial infarction, and stroke. Measurement of Lp(a) allows a more accurate assessment of cardiovascular risk, especially in patients whose cholesterol levels cannot be adequately controlled with statin therapy alone.
How is dyslipidemia treated?
Dietary therapy. Nutritional correction is a cornerstone of treatment. Patients are advised to:
- Increase dietary fiber intake (vegetables, fruits, whole grains).
- Limit saturated fats and trans fats.
- Include foods rich in omega-3 fatty acids (fish, flaxseed oil).
Physical activity. Regular aerobic exercise helps reduce LDL cholesterol and triglycerides while increasing HDL cholesterol.
Pharmacological treatment. The following medications may be prescribed:
- Statins. These drugs lower total cholesterol, particularly LDL cholesterol (“bad cholesterol”), by inhibiting the HMG-CoA reductase enzyme. They are among the most effective agents for the prevention of atherosclerosis and ischemic heart disease.
- Fibrates. Medications primarily aimed at reducing triglyceride levels and increasing HDL cholesterol. They also improve the overall lipid profile and have anti-inflammatory effects.
- PCSK9 inhibitors. Novel agents that significantly reduce LDL cholesterol by enhancing the activity of LDL receptors responsible for cholesterol clearance from the bloodstream. They are particularly useful in patients with familial hypercholesterolemia or those who do not achieve target lipid levels with statins.
- Small interfering RNA (siRNA) therapies. These molecules inhibit the synthesis of specific proteins involved in lipid metabolism. An example is inclisiran, which lowers LDL cholesterol through RNA interference and is used in patients with markedly elevated cholesterol levels when other therapies are insufficient.
- Cholesterol absorption inhibitors. Agents such as ezetimibe reduce intestinal absorption of cholesterol, lowering overall blood cholesterol levels. They are often used in combination with statins to enhance lipid-lowering effects.
- Bempedoic acid. A lipid-lowering agent that, similarly to statins, inhibits cholesterol synthesis from acetyl-CoA. Its active metabolite is formed only in the liver, which minimizes muscle-related adverse effects. Bempedoic acid can be used in patients at high risk of atherosclerotic cardiovascular disease, either in combination with statins, as monotherapy, or together with ezetimibe in cases of statin intolerance.
Weight reduction and cessation of smoking and alcohol consumption significantly improve the lipid profile.
Monitoring. Regular follow-up with a physician and periodic lipid profile testing allow timely adjustment of therapy.
The treatment of dyslipidemia in Belarus is based on a comprehensive approach that combines lifestyle modification, pharmacological therapy, and management of comorbid conditions. Regular medical supervision and adherence to treatment recommendations significantly reduce the risk of cardiovascular complications, improve quality of life, and increase life expectancy.
