Introduction

Hyperlipidaemia is an abnormally high amount of lipids (fats) in the blood, such as cholesterol and triglycerides.  It can be cholesterol or fats; it's the same thing. A total cholesterol level of less than 200 mg/dL (5.2 mmol/L) is considered desirable. While lipids are essential for various bodily functions, including hormone production, cell membrane structure, and energy storage, excessive levels can lead to serious health problems. These include stroke, diabetes, and, most notably, cardiovascular diseases. Hyperlipidaemia is a common condition affecting approximately 32.8% of the population in the US. Although figures may be slightly lower in the UK, the prevalence remains significant 

High-density lipoproteins (HDL)  are good cholesterol as they are beneficial for humans, and they are essential for the body to produce hormones and cells and build up muscle mass. If they are in excess, then the liver removes the excess amount to avoid buildup in the blood vessels. Higher levels of HDL are associated with a lower risk of heart disease.

Now comes the dangerous cholesterol, i.e., Low-density lipoprotein (LDL); they are the problematic cholesterol which is not beneficial for the body, and they tend to deposit in the arteries and cause blockage, so smooth blood flow is interrupted. If the deposition occurs beyond the normal amount, it will lead to heart problems.

Hyperlipidaemia and its connection with Heart enlargement 

Hyperlipidaemia: increased cholesterol and triglyceride levels are linked with heart enlargement in the following ways:

Atherosclerosis

Large values of LDL can be deposited in the arteries, which causes plaque formation, which narrows the arteries so it gets difficult for blood to flow through the arteries at normal pressure, so this causes the heart to pump rapidly to maintain proper blood circulation throughout the body, but this puts a strain on the heart muscles, eventually leading to hypertrophy (enlargement).²

Increased Blood pressure 

As these arteries get narrower, the heart has to work much harder to push blood through these narrow paths. This lays a lot of extra burden on the heart muscles, causing them to become larger and thicker, which is referred to as left ventricular hypertrophy. It alters the shape of the heart and makes it large.

Risk Factors

Genetics

Genetics plays a huge role in hyperlipidaemia. If you already have a parent or close family relative with this condition then it is likely you will be affected by this condition if proper care is not taken.

Diet

If your diet includes high saturated fats, processed meats, and full-fat dairy, then this can lead to high levels of LDL, which is bad for your health.

Physical inactivity

You must have a healthy lifestyle rather than a sedentary one, as exercise will lead to proper blood circulation throughout the body and will also put less workload on the heart. Lack of exercise, on the other hand, contributes to weight gain and LDL increase.

Smoking

Studies have shown that smoking can cause increased levels of LDL and triglycerides and decreased HDL.³

Obesity

Obese people have excess body fat, especially visceral fat, which is associated with high LDL levels and low HDL levels.⁴

Age and gender

Cholesterol level increases with increasing age; men tend to have higher levels of cholesterol as compared to women, mostly after menopause.

Treatments for Hyperlipidaemia

Statins

Statins are the 1st choice of drug for lowering the cholesterol level in the blood. They are prescription drugs, i.e., you need a proper diagnosis and doctor’s note to be treated with this medication. Statins lower the cholesterol level in the blood by inhibiting the enzyme hydroxymethylglutaryl-CoA reductase in the liver. This enzyme produces cholesterol in the blood. So, simply by just inhibiting these enzymes, the cholesterol levels in the blood are decreased.⁵

Some common statins include:

• Atorvastatin (Lipitor®)
• Fluvastatin
• Lovastatin (Mevacor® )
• Pitavastatin (Livalo® or Zypitamag®)
• Pravastatin
• Simvastatin (FloLipid®)
• Rosuvastatin (Crestor®)

PCSK9 inhibitors 

They are a class of drugs that lower LDL cholesterol levels and reduce the risk of cardiovascular disease. PCSK9 inhibitors are injectable monoclonal antibodies that block the PCSK9 protein in the liver, which lowers the LDL cholesterol in the blood.

These medications are generally prescribed when statins have failed to show a therapeutic effect. 

PCSK9 inhibitors include:

• Alirocumab  
• Evolocumab

Fibrates 

Fibrates work primarily by reducing triglycerides levels and modestly raise HDL, filtrates activate peroxisome proliferator-activated receptor alpha (PRAR-α). It breaks triglyceride molecules and raises the production of HDL, the good high-density lipoprotein.

Fibrates are extremely useful in those patients who have high levels of triglycerides, commonly found in the condition of metabolic syndrome or diabetes. This decrease in triglycerides would reduce the incidence of pancreatitis and thus improve the fatty acid balance - all added benefits for the heart.

Common Fibrates are

• Fenofibrate 
• Gemfibrozil

Bile Acid Sequestrants

Bile acid sequestrants bind to bile acids in the intestines to stop their reabsorption, which may decrease the bile levels, so more bile acid has to be produced. Since bile acid is made from cholesterol, more cholesterol molecules are available for the liver to synthesise additional bile acids, thus lowering blood levels of cholesterol.

These are not the first line of treatment and are used for those patients in which statins have not been effective or for those patients who cannot tolerate statins.

Bile acid Sequestrants include:

• Cholestyramine 
• Colesevelam

Omega-3 Fatty Acid Supplements

Omega-3 fatty acids decrease triglyceride levels by decreasing triglyceride synthesis in the liver and removing triglyceride-rich particles from the blood.

Omega-3 supplements cut down on triglycerides and reduce inflammation, ultimately protecting against heart problems. They are greatly useful when one's triglyceride level is high

They include 

• Eicosapentaenoic Acid (EPA)
• Docosahexaenoic acid (DHA)

Non-pharmacological treatment options

Non-pharmacological options refer to treatment without the use of medications. Yes, it is possible to manage your condition if it's the beginning of the disease, and the following methods can do it.

Dietary modifications

The easiest way to prevent heart enlargement is by managing your diet. You should avoid eating food high in sodium, saturated fat, and processed food. These foods can raise cholesterol levels, as they are mostly LDL, and you may have a higher chance of getting heart disease.

Some of the foods beneficial for managing high lipid levels include:

Soluble fibre 

They dissolve in the stomach and slow down the absorption of fats, which keeps normal cholesterol levels in the body.⁷ These foods include: 

• Fruits: apples, bananas, strawberries, avocado
• Vegetables: Carrots, Broccoli, Peas
• Grains: oats, Barley
• Legumes: Lentils, chickpeas

Insoluble fiber

Insoluble fibres are not digested in the body; they increase the stool bulk, ensuring proper bowel movements. Insoluble fibre does not have a significant impact on the cholesterol level as compared to soluble fibres, but including this in your diet will surely make you healthy. They include foods such as 

• Corn
• Brown flour
• Brown rice
• Green leafy vegetables
• Almonds
• Walnuts

A lifelong management of diet can save you from numerous health conditions and improve overall well-being. By treating hyperlipidaemia you will not only be managing heart conditions but also many other chronic conditions such as diabetes.

Meditation and stress management

Meditation and stress level management are great options for managing hyperlipidaemia and even treating it. As studies⁶ have shown, increased stress leads to more production of cortisol and cholesterol, so higher cholesterol cause hyperlipidaemia, ultimately causing heart enlargement.

However, you can reduce stress levels by meditation, reaching out to family for support, doing breathing exercises, and practising yoga, which supports overall heart health. 

Support Programs

Support programmes are like a helping guide that plans the diet plans and provides the guidance for the exercises and other changes an individual has to make to reduce cholesterol levels of the patient. Along with physical improvement, they also help the patient's mental health by assuring them of positive outcomes of the efforts. This increases the patient's willingness to follow the plans accordingly for fast recovery.

Summary

Hyperlipidaemia is a disease in which there are increased levels of LDL, (“bad” cholesterol). These increased levels of LDL are deposited in the arteries, which causes the blockage, and the blood is unable to circulate normally throughout the body. The heart, therefore, pumps rapidly to increase the pressure to circulate the blood, but if this persists for a long time, it causes the heart to be bigger than its original size, which can cause heart enlargement and other complications. Hyperlipidaemia can be treated or managed with statins, fibrates, bile acid sequestrants, omega-3 supplements, and PCSK9 inhibitors that effectively lower cholesterol and triglycerides.  A non-pharmacological approach is also valuable, which is meditation, stress management, and support management.

FAQs

What is the first-line management and treatment of hyperlipidaemia?

The first line of treatment for hyperlipidaemia includes dietary restrictions, physical exercise, and weight management.⁸

What is the best treatment for hyperlipidaemia?

The best treatment for hyperlipidaemia is statins. They are the best medications for people with heart conditions and have proven very effective.

Which drink removes cholesterol?

The cholesterol levels can be lowered by green tea, pomegranate juice, beet juice, and soy milk.

What are the signs and symptoms of Hyperlipidaemia?

You might feel a sudden leg cramp, chest pains, trouble breathing, shortness of breath, weakness, and fatigue.

How can I reduce Cholesterol within a week?

You can start by improving your diet, such as eating fruits and vegetables, yoghurt, and protein, and during this time, you must avoid saturated fats, processed foods, and any kind of fried foods.