Dyslipidemia: Abnormal Level Cholesterol in Blood

Dyslipidemia, a medical condition characterized by abnormal levels of lipids (fats) in the blood, has become a significant public health concern worldwide, including in Bangladesh

Dyslipidemia Patients in Bangladesh

Dyslipidemia, a medical condition characterized by abnormal levels of lipids (fats) in the blood, has become a significant public health concern worldwide, including in Bangladesh. The disorder encompasses elevated cholesterol, triglycerides, low-density lipoprotein (LDL), or low levels of high-density lipoprotein (HDL). It is a critical risk factor for cardiovascular diseases (CVD), which are currently the leading cause of morbidity and mortality in Bangladesh.

How to Devlop Dyslipidemia

Genetic Factors

a) Primary Dyslipidemias: These are often due to genetic mutations affecting lipid metabolism. Examples include familial hypercholesterolemia (caused by mutations in the LDL receptor gene) and familial combined hyperlipidemia.
b) Polygenic Influence:In many cases, dyslipidemia arises from the interplay of multiple genes that contribute to variations in lipid levels, affecting pathways such as cholesterol synthesis, transport, and clearance.

Dietary and Lifestyle Factors

a) High Fat and Sugar Intake:Diets high in saturated fats, trans fats, and simple sugars can increase LDL-C and triglyceride levels while reducing HDL-C.
b) Sedentary Lifestyle: Physical inactivity can reduce the activity of enzymes involved in lipid metabolism, such as lipoprotein lipase, leading to an accumulation of triglycerides.
c) Alcohol Consumption: Excessive alcohol intake can increase triglyceride levels through enhanced hepatic lipogenesis.

Obesity and Insulin Resistance

a) Increased Adiposity:Excess fat, particularly visceral fat, contributes to dyslipidemia by increasing the release of free fatty acids (FFA) into circulation, leading to elevated triglyceride production in the liver.
b) Insulin Resistance: Often associated with obesity and metabolic syndrome, insulin resistance results in reduced suppression of hormone-sensitive lipase in adipose tissue, leading to an increase in free fatty acid flux to the liver. This accelerates the production of very-low-density lipoproteins (VLDL) and increases serum triglycerides while reducing HDL-C.

Hepatic Overproduction of Lipoproteins

The liver plays a crucial role in lipid metabolism. Overproduction of VLDL by the liver can lead to hypertriglyceridemia. Hepatic steatosis (fatty liver) is often a contributing factor, enhancing the secretion of VLDL.

Impaired Lipid Clearance

Defects in the clearance of lipoproteins, such as reduced activity of LDL receptors or diminished function of HDL in reverse cholesterol transport, can lead to elevated plasma cholesterol and triglyceride levels.

Hormonal Influences

a)Thyroid Hormones: Hypothyroidism reduces the activity of hepatic lipase and LDL receptor function, leading to increased serum cholesterol levels.
b) Sex Hormones: Changes in estrogen levels, such as during menopause, can lead to increased LDL-C and decreased HDL-C levels.

Chronic Inflammation

Inflammatory states (e.g., in metabolic syndrome, obesity, and type 2 diabetes) can alter lipoprotein metabolism by affecting enzymes like lipoprotein lipase and cholesterol ester transfer protein (CETP), resulting in elevated levels of triglycerides and decreased HDL-C.

Medications

Certain drugs (e.g., corticosteroids, antipsychotics, beta-blockers) can alter lipid metabolism, leading to dyslipidemia

Prevalence of Dyslipidemia in Bangladesh

In Bangladesh, the prevalence of dyslipidemia is rising day by day, attributed to rapid urbanization, changes in lifestyle, unhealthy dietary habits, and increased prevalence of other health conditions like obesity/overweight, hypertension, and diabetes Mellitus. Several studies suggest that dyslipidemia affects a considerable portion of the adult population, particularly those in urban areas. A cross-sectional survey conducted in recent years found that nearly 30-40% of adults in urban settings exhibit some form of lipid abnormality, while rural areas are also catching up due to changing lifestyles and food habits.

The burden of dyslipidemia in Bangladesh is compounded by limited awareness and screening practices. Many individuals remain undiagnosed due to the asymptomatic nature of dyslipidemia, which can silently progress into severe cardiovascular complications such as heart attacks, strokes, and atherosclerosis. The absence of routine lipid profile testing in primary healthcare settings contributes to delayed diagnosis and treatment

Risk Factors to develop Dyslipidemia

Several factors contribute to the growing prevalence of dyslipidemia in the Bangladeshi population:

  1. Dietary Patterns: Traditional Bangladeshi diets, often high in saturated fats, refined carbohydrates, and trans fats, contribute to abnormal lipid profiles. Increased consumption of processed foods, sugary drinks, and fast food, especially in urban areas, has further exacerbated the risk.
  1. Sedentary Lifestyle: Urbanization has led to a more sedentary lifestyle, with reduced physical activity among the population. This lifestyle change has been linked to increased body weight, insulin resistance, and abnormal lipid metabolism, culminating in dyslipidemia.
  2. Genetic Predisposition: Genetic factors also play a role in the prevalence of dyslipidemia. Certain populations, including South Asians, have a genetic predisposition to dyslipidemia, making them more vulnerable to developing CVD at an earlier age compared to other ethnic groups.
  3. Coexisting Health Conditions: The high incidence of obesity, hypertension, and diabetes in Bangladesh serves as a major risk factor for dyslipidemia. Insulin resistance and metabolic syndrome, closely associated with obesity and diabetes, are known to cause lipid abnormalities.
  4. Lack of Awareness and Healthcare Access: Despite its rising prevalence, public awareness regarding dyslipidemia remains low. Furthermore, access to healthcare services, especially in rural areas, is limited. These factors result in inadequate screening, delayed diagnosis, and insufficient management of the condition.

Health complications of Dyslipidemia

Dyslipidemia is a silent threat that significantly increases the risk of developing cardiovascular diseases, which are already the leading cause of death in Bangladesh. Elevated levels of LDL cholesterol contribute to plaque buildup in arteries, leading to atherosclerosis, heart attacks, and strokes. Conversely, low HDL cholesterol levels reduce the body’s ability to remove excess cholesterol, further aggravating the risk of CVD. Moreover, high triglyceride levels are associated with an increased risk of acute pancreatitis and other metabolic disorders.

Management and Treatment of Dyslipidemia

The management of dyslipidemia in Bangladesh involves a combination of lifestyle modification, pharmacotherapy, and public health interventions. Strategies include:

  1. Lifestyle Modifications: Adopting a heart-healthy diet(Such as Mediterranean Diet, increasing physical activity, and quitting smoking are fundamental to managing dyslipidemia. Public health campaigns promoting dietary changes, like reduced intake of saturated fats, trans fats, and sugars, along with increased consumption of fruits, vegetables, and whole grains, are essential. Encouraging physical activity through community programs and accessible public spaces can further aid in controlling lipid abnormalities.
  2. Pharmacotherapy: For individuals with significant lipid abnormalities or those at high risk of cardiovascular events, medications such as statins, fibrates, niacin, and cholesterol absorption inhibitors are commonly prescribed. In Bangladesh, access to lipid-lowering drugs is generally available in urban areas; however, affordability and accessibility remain a concern for many, particularly in rural settings.
  3. Regular Screening and Monitoring: Enhancing awareness and implementing regular screening programs for lipid profile checks, particularly for high-risk populations, are crucial. Early detection of dyslipidemia can prevent the progression of cardiovascular diseases.
  4. Public Health Initiatives: Government and non-governmental organizations in Bangladesh are increasingly focusing on public health interventions to combat dyslipidemia. This includes educational campaigns on healthy eating, the dangers of trans fats, and the importance of physical activity. Integrating dyslipidemia management into primary healthcare services, especially in rural areas, can significantly improve early detection and intervention.

Challenges in Addressing Dyslipidemia in Bangladesh

Bangladesh faces several challenges in tackling dyslipidemia effectively:

Limited Healthcare Infrastructure: The healthcare infrastructure, especially in rural areas, lacks the necessary facilities for routine lipid profile screening and comprehensive CVD management.
Socioeconomic Barriers: Poverty and lack of education limit access to healthcare services and medications. Many patients cannot afford regular screening or medication, leading to uncontrolled lipid levels and increased risk of CVD.
Cultural and Lifestyle Factors: Traditional dietary habits, cultural norms, and resistance to lifestyle changes pose significant challenges in implementing effective dietary and physical activity interventions.

Dyslipidemia represents a growing health issue in Bangladesh, contributing significantly to the country’s burden of cardiovascular diseases. While urbanization and changing lifestyles have escalated the prevalence of lipid abnormalities, limited awareness, inadequate healthcare access, and socioeconomic factors hinder effective management. Addressing dyslipidemia requires a multifaceted approach involving public education,Nutritional Education lifestyle modification, improved healthcare services, and government-led public health initiatives. By enhancing screening, raising awareness, and making treatment more accessible, Bangladesh can make significant strides in reducing the morbidity and mortality associated with dyslipidemia and its cardiovascular complications.

Author: Dr Md Noman Islam Nirob, MBBS, DMU, MSc(Ongoing)

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