Reading time: 5 minDyslipidemias can be caused by both congenital and acquired factors and are characterized by qualitative and quantitative alterations in plasma lipids and lipoproteins. Numerous epidemiological data and studies conducted in animal models have contributed to increasing awareness of the association between dyslipidemias, atherosclerosis, and coronary heart disease.
The incidence of these diseases has increased significantly and constitutes the leading cause of death in industrialized countries and in many developing countries.
In several epidemiological studies, the main risk factors have been identified as hypercholesterolemia and hypertriglyceridemia (and with them high levels of apoprotein B) and low HDL cholesterol (and with it low levels of apoprotein A1).
Lipid risk factor modification is an integral part of cardiovascular disease management and large intervention studies have shown that by reducing blood cholesterol levels, it is possible to reduce the incidence of clinical events (myocardial infarction, stroke, sudden death). (1-2)
Hypercholesterolemia
Every day our body absorbs a certain amount of cholesterol (exogenous cholesterol) in the intestine and produces an even greater amount (endogenous cholesterol).
In the body, exogenous cholesterol comes from the diet, but the majority is synthesized by the body independently of the amount introduced with food.
In fact, the increase in the quantity of cholesterol ingested daily determines only a small increase in plasma concentration, although the individual response can vary significantly. Generally, intestinal absorption cannot exceed values around 1 gram per day and, furthermore, when cholesterol is ingested, it determines an increase in cholesterolemia with consequent inhibition of 3-hydroxy-3-methylglutaryl-CoA reductase, an enzyme necessary for its endogenous synthesis, thus implementing an intrinsic feedback control system that regulates the concentration of plasma cholesterol. (3)
On the other hand, following a diet based on saturated fats, cholesterolemia can increase considerably and this is due to the deposition of fats in the liver which results in a greater quantity of acetyl-CoA available in the liver cells to synthesize cholesterol. (4)
Cholesterol is transported by lipoproteins, of which there are several types:
Very low density lipoproteins (VLDL)
The acronym VLDL stands for very low-density lipoproteins. They are synthesized by the liver and contain a higher amount of triglycerides than LDL, of which they are precursors.
Low-density lipoproteins (LDL)
Low-density lipoproteins, also known as LDL (Low Density Lipoproteins) cholesterol or “bad cholesterol” are the most numerous in circulation in the blood.
High-density lipoprotein (HDL)
HDL, also known as “good cholesterol,” is a type of high-density lipoprotein.
The quantity of these lipoproteins and the ratio between them defines a person's cardiovascular risk.
Hypertriglyceridemia
Triglycerides are fats present in the blood.
When excessive amounts of fat and sugar are consumed, triglycerides will also be elevated. High blood triglyceride levels are a major risk factor for cardiovascular disease: they can promote the onset of atherosclerosis, heart attack, and stroke.
To more comprehensively assess a subject's cardiovascular risk, triglyceride levels are measured alongside total cholesterol and its fractions (HDL cholesterol and LDL cholesterol).
How to lower cholesterol and triglycerides in the blood?
The guidelines give us many great suggestions:
Diet
- Choose whole grains and foods rich in fiber
- Follow a diet rich in vegetables and fruit
- Consume fish, especially fatty fish, rich in omega-3 at least twice a week
- Limit the intake of saturated fatty acids to < 7% of energy intake, trans fatty acids to < 1% and cholesterol to < 300 mg per day by consuming lean meats or plant-based alternatives, skimmed or low-fat milk and dairy products, and minimize the intake of partially hydrogenated fats.
- Minimize intake of sugar-added foods and drinks
- Choose and cook foods with little or no salt
- Moderate use of alcohol
It has been highlighted in several studies that the antioxidants present in fruit and vegetables and in olive oil have a positive effect and correlate with a significant increase in hypercholesterolemia (5-6-7-8)
Physical activity
Practice regular aerobic exercise; a lack of exercise predisposes to heart disease. At least 30 minutes of aerobic activity per day is recommended.
Smoke
Cigarettes lower HDL cholesterol, which helps remove LDL cholesterol from the inner walls of the arteries.
Use of nutraceuticals
- Monacolin K: derives from the extract of red yeast rice or the product resulting from the fermentation of red rice by the fungus Monascus PurpureusMonacolin K is structurally identical to lovastatin. The lipid-lowering mechanism of action of red yeast rice is therefore due to the reversible inhibition of the enzyme 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase (a key enzyme in the endogenous synthesis of cholesterol). (9-10)
- BerberineBerberine is a natural substance found in various plants of the Berberidaceae family. Treatment with berberine is associated with increased membrane expression of a receptor protein capable of internalizing LDL, a mechanism that does not involve the enzyme HMG-CoA reductase. Berberine is essentially able to increase the expression of the LDL receptor, but some studies show that it could probably also reduce LDL cholesterol by inhibiting cholesterol absorption and increasing its excretion. (11-12)
- Omega-3: Omega-3s are polyunsaturated fats considered essential. Specifically, their precursor (alpha-linolenic acid, ALA) cannot be synthesized by the body, and therefore must be consumed through diet or supplementation. Alpha-linolenic acid (ALA) contributes to the maintenance of normal blood cholesterol levels, while EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) contribute to the proper functioning of the heart and cardiovascular system.
- Naringin: it is a flavonoid present in the fruits of the Citrus genus that is emerging for its notable nutraceutical value. Epidemiological, clinical and pre-clinical evidence demonstrates that its intake significantly reduces the incidence of cardiovascular diseases, several preclinical studies confirm that flavanones can influence the progression of atherosclerosis. (13-14)
- Polygonum Cuspidatum: It is a plant native to East Asia. From the root of the plant we obtain Resveratrol, a powerful polyphenol that has an antioxidant, cardioprotective and antithrombotic action. It also lowers blood pressure, reduces cholesterol and triglycerides and improves microcirculation.
We can find these components in two nutraceuticals formulated by Nutrifarma
Ateronorm plus: Contains Monacolins from red rice, Naringin, Berberine and Polygonum cuspidatum for the normal function of the cardiovascular system and Niacin.
Aterolip plus: Made up of Monacolins from Red Rice, Berberine, Naringin, Polygonum Cuspidatum EPA 560 mg and DHA 230 mg for cardiovascular function.
Bibliographic references
1) Export Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEPT) Export Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Jama 2001; 285: 2486-97.
2) Wilson PWF, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, and Kannel W. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-47.
3) Stampfer MJ, Sacks FM, Salvini S, Willett WC, Hennekens CH. The Physicians Health Study. N Engl J Med 1991; 325: 373-81.
4) Grover SA, Coupal L, Hu XP. Identifying adults at increased risk of coronary disease. How well do the current cholesterol guidelines work? JAMA 1995; 274: 801-06.
5) Trichopoulou A. et al. Adherence to a Mediterranean diet and survival in a greek population. N Eng J Med 2003; 348 (26) :2559-2608.
6) Sofi F. et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008; 337: 1344-1351.
7) De Lorgeril M et al. Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon diet heart study. Circulation 1999; 99: 779-85.
8) Barzi F et al. Mediterrean diet and all-cause mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr 2003; 57 (4): 604-611.
9) J Antibiot (Tokyo) 33.3 (1980): 334–6. Monacolin K, a new hypocholesterolemic agent that specifically inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase.
10) Am J Clin Nutr. 1999 Feb;69(2):231-6. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM and Go VL.
11) Birdsall TC et al. Berberine: therapeutic potential of an alcaloid found in several medicinal plants. Altern Med Rev. 1997;2:94-103
12) Kong W et al. Berberine is a novel cholesterolo lowering drug working through unique mechanism distinct from statins. Nat Med 2004; 10(12):1344-1351.
13) Yamada T, Hayasaka S, Shibata Y, Ojima T, Saegusa T, Gotoh T, Ishikawa S, Nakamura Y, Kayaba K, Jichi Medical School Cohort Study Group. (2011) Frequency of Citrus fruit intake is associated with the incidence of cardiovascular disease: the Jichi Medical School cohort study. J Epidemiol 21(3) 169-175
14) Onakpoya I, O’Sullivan J, Heneghan C, Thompson M (2015) The Eff ect of Grapefruits (Citrus
paradisi) on Body Weight and Cardiovascular Risk Factors: A Systematic Review and Metaanalysis of Randomized Clinical Trials.
