HbA1c (average 3 months blood sugar)
Lipids (HDL, LDL, TR, CHOL)

Lipids as Lifestyle Dyslipidaemia

An abnormal lipid profile is closely related to risk of cardiovascular disease and is linked to several metabolic disorders such as diabetes. Compelling evidence has shown that diet/lifestyle interventions may affect circulating lipid profiles. Although many challenges exist, studies in the area of lipidomics (research in lipids) holds promise to qualify future personalized diet, lifestyle and medical interventions aiming on improving lipid profiles in order to mitigate related diseases.

Trace® measures your Total Cholesterol (CHOL), High Density Lipoprotein (HDL), non-HDL, Triglycerides (TG) and calculate values for Low Density Lipoprotein (LDL). There is no natural cut-off between normal and abnormal lipid levels because lipid measurements are continuous. However, a linear relation exists between lipid levels and risk of cardiovascular disease, meaning that any lowering of lipid levels will decrease risk of cardiovascular disease. Proof of benefit of interventions is strongest for lowering LDL levels, while emerging evidence indicates that this is also the case when lowering elevated TG levels and increasing low HDL levels. After using Trace® to test your Lipids use below table to locate your status.

 

Some important statements/publications

  • Reduce your cholesterol via lifestyle changes

    Evert AB, Diabetes Care, 2013
  • Improving your lipid profile decreases the risk of cardiovascular disease

    Lewis SJ, Ann Intern Med, 1998 & Colhoun HM, Lancet, 2004
  • A 0.1 mmol/L reduction in triglycerides causes a 5% reduction in the risk of severe cardiovascular disease

    Jun M, Lancet, 2010
  • A 1 mmol/L reduction In LDL cholesterol reduces the risk of cardiovascular morbidity and mortality by 22 %

    Baigent C, Lancet 2010
  • A 5-10 % weight loss results in lower blood pressure and an improved lipid profile

    Haslam DW, Lancet, 2005

Dyslipidaemia

Dyslipidaemia is defined as any abnormality in lipid-levels while hyperlipidaemia strictly concerns the elevation of total cholesterol (CHOL) and triglycerides (TGs). Hyperlipidaemia is known to contribute significantly to the development of atherosclerosis. Arteriosclerosis is the thickening, hardening and loss of elasticity of the walls of arteries. This process gradually restricts the blood flow to one's organs and tissues and can lead to severe health risks brought on by atherosclerosis, which is a specific form of arteriosclerosis caused by the buildup of fatty plaques, cholesterol and some other substances in and on the artery walls. As plaque continues to build, the blood and oxygen supply to the affected regions will drastically decrease due to the narrowing of the lumen. Eventually, the plaque build up could potentially lead to the complete occlusion of the arteries, leading to a variety of medical problems, like heart attack and stroke. These effects causes arteriosclerosis to be the greatest killer of the 21th century. Causes are primarily caused by lifestyle, but may also include genetic factors for some patients.

Diagnosis

Diagnosis of any dyslipidaemia is made by measuring a lipid profile consisting of CHOL, TGs and individual lipoproteins (LDL and HDL). Dyslipidaemia is suspected in patients with known risk factors, characteristic objective findings, and/or complications of dyslipidaemia (e.g., atherosclerotic disease). Genetic lipid disorders are suspected when patients have physical signs of dyslipidaemia, onset of premature atherosclerotic disease (at < 60 yrs.), a family history of atherosclerotic disease, or CHOL > 240 mg/dL (> 6.2 mmol/L).

Treatment

  • Dietary changes incl. reduction of fat intake
  • Increased physical activity, and if indicated, weight loss
  • Medical treatment with e.g. a statin (lipid lowering drug)

There is no natural cut-off between normal and abnormal lipid levels because lipid measurements are continuous. A linear relation probably exists between lipid levels andrisk of cardiovascular disease, meaning that any lowering of lipid levels will decrease an individual’s risk of cardiovascular disease. Consequently, there are no numeric definitions of dyslipidaemia and the term ”dyslipidaemia” is applied to lipid levels for which treatment has been proven beneficial. Proof of benefit of interventions is strongest for lowering elevated low-density lipoprotein (LDL) levels. Even so, emerging evidence indicates that this is also the case when lowering elevated TG and increasing low high-density lipoprotein (HDL) levels.

 

Diabetes

Patients with type 2 diabetes are especially at risk of dyslipidaemia and tend to have an especially atherogenic combination of high TG, high LDL and low HDL levels named diabetic dyslipidaemia. This condition is a major risk of cardiovascular disease and women with diabetes seems to be at special risk. The lipid changes are attributed to hyperinsulinaemia, associated to low HDL levels and insulin resistance, leading to increased free fatty acid (FFA) levels and thereby causing increased hepatic very-low density lipoprotein (VLDL) production. Diabetic dyslipidaemia is often exacerbated by the increased caloric intake and physical inactivity, both of which characterize the lifestyle of some patients with type 2 diabetes. Management of diabetic dyslipidaemia starts with lifestyle changes and a plan for achieving normal glucose levels.

Lifestyle causes

Lifestyle characteristics such as alcohol consumption, smoking, obesity, a sedentary lifestyle, or all, contributes to numerous cases of dyslipidaemia in adults. The most important lifestyle cause in developed countries is a sedentary lifestyle with excessive dietary intake of saturated fat, cholesterol and trans fats.

Related tests

Measurements of LDL particle number or Apoprotein B-100 (Apo B) may be useful in patients with elevated TGs and the metabolic syndrome. Apo B is a protein contained in each LDL and VLDL particle. Apo B provides somewhat similar information to LDL, but may potentially be a more precise risk-marker for cardiovascular disease; this is yet to be established.

Other tests for lifestyle causes

Examinations for secondary causes of dyslipidaemia includes measurements of HbA1c, liver enzymes, creatinine, thyroid-stimulating hormone (TSH), and urine tests. These are to supplement the medical examination, medical history and use of medication.

Framingham Risk Tables for Men and Women

The Framingham Risk Score is a male/female specific algorithm used to estimate 10-year cardiovascular risk. You can use it to calculate your risk of cardiovascular disease based on specific parameters including your age, total cholesterol (CHOL), smoking status, HDL-level and systolic blood pressure.
The risk score gives an indication of the likely benefits of prevention by identifying increased risk of future cardiovascular events. The risk score is useful for you and for your doctor in helping decide on the need for lifestyle modifications and/or preventive medical treatment. Low risk is 10% or less, intermediate risk 10-20%, and high risk 20% or more. It should be remembered that these categorisations are arbitrary and only indicative of risk/benefits of lifestyle modifications.

Lipids as Genetic Dylipidaemia

Primary causes involve gene mutations that cause the body to produce too much LDL or triglycerides or to fail to remove those substances. Some causes involve underproduction or excessive removal of HDL. Primary causes tend to be inherited and thus to run in families. Cholesterol and triglyceride levels are highest in people with hereditary dyslipidemias, which interfere with the body’s metabolism and elimination of lipids. People can also inherit a tendency for HDL cholesterol to be unusually low.