Familial combined hyperlipidaemia should be suspected in an individual with moderate to severe mixed hyperlipidaemia (typically serum total cholesterol 6.5-8.0 mmol/l and serum triglycerides [TG] 2.3-5.0 mmol/l), and a family history of hyperlipidaemia or premature CHD (not due to familial hypercholesterolaemia).
It is further sub-divided into :-Low-density lipoproteins (LDL or "bad" cholesterol) that deliver cholesterol to the body, while high-density lipoproteins (HDL or "good" cholesterol) that takes cholesterol out of the bloodstream. A correlation exists between high blood-cholesterol levels and heart disease.
Increased LDL and decreased HDL levels leads to Dyslipidaemia, whereas an increased amount of fat in the blood is known as Hyperlipidaemia. The principal fat in the blood is cholesterol, a naturally occurring substance utilized in creation of body hormones like estrogen and testosterone. Cholesterol is also an essential component of the membrane that surrounds individual cells of the body.
Because fat is insoluble, cholesterol must be bound to proteins when it is transported in the blood. This complex of fat and protein is called a lipoprotein. Because hyperlipidemia is a pervasive problem in the United States, the National Institutes of Health established the National Cholesterol Education Program. Part of this program includes three principal lipoproteins target levels, LDL, HDL, and triglyceride in people with and without coronary heart disease.
It is an important risk factor in developing atherosclerosis and heart disease. Hyperlipidemia may be caused by genetic factors, as in certain familial diseases, or by secondary factors in acquired hyperlipidemia.
Forms of lipids in the blood are cholesterol, Triglycerides, and lipoproteins, which are molecules of fat and cholesterol linked to protein. Types of lipoproteins are: very low-density lipoproteins (VLDL), low-density lipoproteins (LDL) and intermediate-density lipoproteins (IDL). Chylomicrons are also classified as lipoproteins and are composed of Triglycerides, cholesterol and protein.
There are also high-density lipoproteins (HDL) that are inversely related to heart disease risk and are therefore known as "anti-risk" factors. HDL cholesterol 60 mg/dL counts as a "negative" risk factor; its presence removes one risk factor from the total count. Hence, the term dyslipidaemia is used for increased LDL and decreased HDL.
Dietary modification is the initial step in treatment. For overweight individuals, weight reduction to ideal body weight is recommended. Reduction of total calories, cholesterol, and saturated fat is appropriate for most people. The degree of dietary restriction is proportional to the degree of the Hyperlipidaemia.
If there is no improvement in lipid blood levels within 2 months after maximal dietary modification, drug therapy is generally initiated. The type of drug chosen depends upon the type of lipoprotein elevated in the serum. Several types of medications are available. Bile sequestrant resins, cholestyramine, colestipol, lovastatin, and nicotinic acid are frequently used.
However, these modern medicines are associated with their own side effects (reducing LPA, increasing homocystein etc) that have given inclination towards natural and safe treatment.
Herbal Ayurvedic products
Plants have a long history of medicinal use, especially in countries like India. Natural herbal treatment forms central part of medicinal treatment in this country. Herbalism is the use of plant material, based on tradition and folklore to treat or prevent disease. Ayurvedic herbs are selected as per their roles in the respective diseases and a combination of herbs is specifically designed to cater the symptoms of patient.
Role of Guggulu in management of Hypercholesterol:
Guggulu consists of gum resin obtained from Commiphora mukul Engl. (Syn. C. wightii (Arnott) Bhandari, Balsamodendron mukul Hook. Ex. Stocks) of family Burseraceae. C. mukul is a small to medium size tree occurring in arid regions of India.
The species has also been introduced under small-scale cultivation in some places of Rajasthan and Haryana.
It is having number of vernacular names like Guggule, Guggala, Gulgulu, Maishakshi gukkal, Mukle -E-Arzag and Indian Bedellium.
Gum resin occurs in light to dark-brown tears with pale-yellow or brown colour. It is slightly sticky to touch and readily burns when coming in contact with fire. Gum resin possesses aromatic odour and is bitter and astringent in taste.
Various pre-clinical and clinical studies suggest that Guggulu extract lowers total lipids, serum cholesterol and triglyceride levels. It has also been reported to reduce the serum b-lipoprotein fraction effectively and to alter the lipoprotein ratio significantly. The oleoresin portion of Guggulu gum also exhibits the anti arthritic and anti-inflammatory activities. Besides, Guggulu has also been credited with anti-obesity properties.
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