A: Lipoproteins are complexes of cholesterol, triglycerides, and phospholipids that are bound to proteins. Dyslipidemia, a total cholesterol level of over 200 mg/dL resulting from an abnormal concentration of serum lipoproteins in the body, contributes to atherosclerosis. It can be caused by many factors, including genetics, consuming a diet high in saturated fats, smoking, taking thiazide diuretics or steroids, and having renal disease, diabetes, metabolic syndrome, or hypothyroidism.
To determine whether a patient has dyslipidemia, the fasting blood test known as a standard lipid panel is performed. It provides four values:
low-density lipoprotein ("bad") cholesterol (LDL-C)-accounts for 60% to 70% of total serum cholesterol; LDL-C should be below 100 mg/dL in healthy adults and below 70 mg/dL if cardiovascular disease or diabetes is present
high-density lipoprotein ("good") cholesterol (HDL-C)-accounts for 20% to 30% of total serum cholesterol; HDL-C should be above 60 mg/dL (levels below 40 mg/dL are considered low and place the patient at risk for cardiovascular disease)
triglycerides-should be below 200 mg/dL
total cholesterol-should be below 200 mg/dL; to obtain your patient's total cholesterol/HDL-C ratio, divide the total cholesterol value by the HDL-C value.
The National Institutes of Health's 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) recommends that therapeutic lifestyle changes are the most effective way to improve a patient's numbers. Here's how.
To increase the HDL-C level, encourage your patient to participate in moderate aerobic exercise, such as brisk walking, cycling, or lap swimming, for 20 to 60 minutes, three to five times a week, depending on his initial fitness level. Emphasize smoking cessation, which can increase the HDL-C level by 15% to 20%. Moderate alcohol consumption (one to two drinks a day), particularly red wine, may also raise the HDL-C level. Monounsaturated fats found in canola and olive oil, avocados, and many nuts will improve the HDL-C level without raising the LDL-C level.
To lower the LDL-C level, teach your patient to avoid trans fats, which are found in processed foods, snacks, and bakery items. The use of trans fats is currently being phased out in processed foods and restaurants across the country. Recommend a Mediterranean-style diet rich in fruit, vegetables, grains, olive oil, and fish.
To lower triglycerides, tell your patient to limit his alcohol intake and to eat fatty fish, such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon, that are high in omega-3 fatty acids.
Understanding how to interpret a standard lipid panel and how to advise your patient about his results is essential. And now you've taken a step in the right direction!!
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