Hypercholesterolaemia – Classification of Types and Their Role in Coronary Heart Disease

The screening, prevention and treatment of hyperlipidaemia is of great importance as it is a major risk factor for Coronary Heart Disease (CHD). CHD has become a major health problem facing communities in the developed world. In Singapore, CHD is the leading cause of death, second only to cancer.

The Role of Lipids In CHD:

1.Total Cholesterol: The risk of CHD begins when Total Cholesterol levels rise above 150 mg/dL (3.9 mmol/L), and this risk escalates sharply when Total Cholesterol exceeds 200 mg/dL (5.2 mmol/L). The type of cholesterol which is most significant, is the LDL-cholesterol ("bad cholesterol") component.
2.LDL-cholesterol: Too much of LDL-cholesterol causes development of atherosclerotic deposits in the walls of arteries, thus increasing the risk for cardiovascular disease and stroke.
3.HDL-cholesterol: Commonly referred to as the "good cholesterol", it has a powerful protective effect against CHD. One should aim to increase HDL levels via exercise and moderate alcohol intake. Obesity, smoking and a sedentary lifestyle all decrease HDL levels.
4.Triglycerides: The association between Triglycerides and CHD is less well established, however, their levels should be controlled in patients with diabetes and high CHD risk.

Risk Factors for CHD:

Non-modifiable Factors:

-Increasing age
-Male gender
-Ethnicity
-Family history of premature CHD

Modifiable Factors:

-High cholesterol levels
-Hypertension
-Diabetes mellitus
-Obesity
-Sedentary lifestyle
-Smoking
-Stress
-Others: elevated homocysteine, lipoprotein(a) and C-reactive protein levels.

Classification of Dyslipidaemias:

Dyslipidaemias may be inherited (if you have a positive family history of hyperlipidaemia, your risk for developing it increases) or acquired (through unhealthy lifestyle choices). There are also some conditions which can secondarily increase cholesterol levels. These include conditions such as diabetes mellitus, chronic renal failure, hypothyroidism, nephrotic syndrome, pregnancy, alcohol abuse, cholestasis and certain drugs (eg. Beta-blockers, corticosteroids, diuretics, oral contraceptives)

What Types of Fats Should You Worry About?

These are the main types of fats:

• Monounsaturated Fats Found in nuts, olive and canola oil,they lower your total cholesterol and raise HDL.
• Polyunsaturated Fats Found in salmon, fish oil and corn, they lower your total cholesterol and lower LDL.
• Saturated Fats Found in animal products, meat, eggs, dairy, coconut and palm kernel oils, they raise total cholesterol, in particular, LDL.
• Trans-Fats Found in fast food and processed foods, they raise LDL and lower HDL.

Who Should Get Tested?
Screening for Total Cholesterol and HDL-cholesterol can be done without fasting. If total cholesterol levels are found to be raised, then you should have your blood tested for Triglycerides and LDL-cholesterol after a fasting period of between 10 – 12 hours.

The following groups should get tested:

• Patients with diabetes
• Patients with CHD, strokes or peripheral artery disease
• Those with a strong family history of hyperlipidaemia
• Those with other risk factors for CHD (as listed above)
• Those having general health screening done

Dr Ang C.D. is has been in medical practice for over 12 years. He graduated with an M.B.B.S. degree from the National University of Singapore in 1997 and subsequently completed his post-graduate diploma in Family Medicine.

He has had training in Emergency Medicine, Internal Medicine, Geriatric Medicine, Orthopaedic Surgery, Obstetrics & Gynaecology, Neurosurgery, General Surgery, Colorectal Surgery and Urology.

Dr Ang currently practices in a family clinic in Singapore, seeing a good mix of paediatric, adult and geriatric patients.

With the goal of providing local and international patients with a resource for specialist care in Singapore, Dr Ang has founded SingaporeDoc.com, a Web Directory of Specialists in Private Practice in Singapore.

http://singaporedoc.com

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