Hypercholesterolemia

Disease information

Hypercholesterolemia

Hipercolesterolemia.

Definition.

Hipercolesterolemia corresponds to an increase of sanguineous cholesterol with respect to a given value. This value is still badly defined. Certain scales define the rate of cholesterol based on the age. Of schematic form it is possible to be said that:

• colesterolemias inferior to 2 g / l is normal or optimal.

• colesterolemias superior to 2. 5 g / l is pathological.

sterificado and triglicéridos and of an envelope composed by apoproteínas, free cholesterol and phospholipids.

1. The lipoproteins.

s. The new knowledge on the metabolism of lipids have made recently appear the notion of "good cholesterol" and "bad cholesterol".

Metabolism of lipids.

The lipids are not soluble either in water and therefore in plasma. With the purpose of being transported in the blood, they are united to a protein fraction, apoproteína, to give rise to a lipoprotein. All the lipoproteins therefore are constituted of a lipídica fraction (triglicéridos cholesterol, phospholipids and) and of a protein.

They schematically have the form of a sphere with a nucleus constituted by esterificado cholesterol and triglicéridos and of an envelope composed by apoproteínas, free cholesterol and phospholipids.

1. The lipoproteins.

Several types of lipoproteins exist that defer according to the nature and proportion from lipids, and his apoproteínas. The lipoproteins are classified by means of two methods: the electroforesis or the ultracentrifugalization.

Electroforesis.

The classification of lipoproteins is made, according to its speed of migration, on a support of cellulose or poliacrilamida, under the action of an electric field. One obtains lipoproteinograma that lipoproteínasa differentiates, b and pre - b according to his relation carga / masa. This method, thanks to the progress of the biochemistry, has been supplanted by the ultracentrifugalization.

Ultracentrifugación.

The density of lipoproteins is determined. The QM (quilomicrones) the VLDL (very low density lipoproteins, lipoproteins of very low density) the LDL (low density lipoproteins, lipoproteins of low density) and the HDL are identified (high density lipoproteins, HD lipoproteins) In this case, the separation takes place based on its mass, obtaining itself different bands from minor from greater density. The QM and the VLDL compound of are essentially triglicéridos. The cholesterol is transported mainly by LDL and HDL. Therefore, the valuation of the total cholesterol represents the sum of two different cholesterols: the cholesterol - HDL, call "good cholesterol" because he is not aterógeno, and the cholesterol - LDL, call "bad cholesterol" since he is aterógeno. The LDL and the HDL have opposed papers in which it concerns to the metabolism of the cholesterol.

Metabolic paper of the LDL (Lipoproteins of low density)

The LDL have like purpose of transporting to all the cells the cholesterol of nutritional origin or synthesis, and the phospholipids for the renovation of plasmáticas membranes. It is the route of entrance of the cholesterol. The LDL, to penetrate in the cell, pays attention to a specific receiver and undergoes an endocytosis. The lipoprotein releases in the cytoplasm cholesterol ester that quickly is hidrolizado under the free cholesterol form.

The intracellular free cholesterol has different destinies:

• Volver to esterificar itself in cholesterol ester by means of the action of an enzyme: the acyl - cholesterol - acyl transferasa (A. C. A. T.

• Llegar at cellular membranes, to get up themselves to them or to cross them and of this form to leave the cell.

If the intracellular free cholesterol is in excess, exist three processes of retro - control that they protect to the cell of a saturation:

• Increase of cholesterol esters by activation of the A. C. A. T.

• Diminution of the synthesis of the endogenous cholesterol by inhibition of the HMG CoA reductasa.

• Inhibition of the synthesis of receivers LDL.

Metabolic paper of the HDL (Lipoproteins of HD)

The route of return (via of ebb tide) of the cellular free cholesterol is represented by the HDL. The free cholesterol in excess constitutes a nonbiodegradable material that is expelled outside the cell. This free cholesterol that crosses the cellular membrane esterificado and is incorporated in lipoprotein HDL, and next it is transported to the liver where it can catabolizado or be eliminated by the bile in biliary acid form. In normal conditions, the currents of entrance and exit of the cholesterol in the cells are balanced. When it is spoken of hipercolesterolemia, it seems interesting to evaluate fraction HDL of the cholesterol, the "good cholesterol", to evaluate the cardiovascular risks.

2. The Apoproteínas.

In order to determine the protein fraction of lipoproteins different immunological techniques are used that they distinguish apoproteínas A1, B, C. The protein fraction of a HDL is essentially apoproteína A1, the one of a LDL apoproteínas A1 is apofracción B. and important B is apoproteínas but of the organism by their concentration and its physiological paper. He is desirable to have high levels of apoproteínas A1 (> 1, 2g / l) and apoproteínas B low (< 1. 35 g / l)

Useful valuations.

In order to evaluate the increase of the risks of cardiovascular pathologies, it is necessary to need as the cholesterol in circulating lipoproteins is distributed. For that reason, it will be necessary to consider the following valuations:

• total Cholesterol and triglicéridos.

• Apoproteína B (protein part of the LDL)

• Apoproteína A1 (protein part of the HDL)

• HDL cholesterol.

• LDL cholesterol.

Treatment.

The treatment of hipercolesterolemia is based on a first time, in the association of an suitable nutritional regime with a fitoterapia treatment. Before beginning any treatment, evidently it is necessary to assure that hipercolesterolemia is not secondary (to see conduct follow)

This treatment is of interest stops:

• the people who have a certain risk: obese people, with drop, hypertense or with cardiovascular antecedents.

• the people who have a total cholesterol level that does not exceed the 3. 5 g / l.

A carried out treatment correctly, where fitoterapia + is associated regime, can standardize lipids after 2 to 3 months.

Treatment.

The nutritional regime to follow in case of hipercolesterolemia is based on 5 essential points:

1) Reducir the fat contribution between 20 and 30% of the caloric total. The saturated and modified fat ingestion is due mainly to reduce to the maximum: margarina, mantequilla, cream, whole milk, greasy cheese, greasy meat (lamb silly pig, charcutería) the fried ones, the baker's shop. The vegetal oils are preferable; the fish.

2) Limitar the nutritional cholesterol less than 300 mg per day (approximately the content of an egg yolk) to avoid the crustaceans, mantequilla, greasy, menudillos cheeses, hunts, greasy meats, eggs.

3) Aumentar complex the carbon hydrate consumption. Fresh, leguminosas fruits and vegetables and cereals, bread, rice, potatoes and pastes.

4) Mantener a daily caloric contribution in agreement with the wished weight (to see treatment obesity)

Treatment.

The hipolipemiantes medicines are classified in different categories based on their composition and of its way from action. Three types exist essentially:

• Fibratos (clofibrato, fenofibrato and derivatives)

• Acid nicotínico and its derivatives.

• Resinas (colestiramina)

The fibratos as well as the nicotínico acid have similar actions: diminution of lipoproteins VLDL and LDL. As far as the colestiramina its action is completely different. The colestiramina is an interchanging ion resin, that is not absorbed by the digestive mucosa that agglutinates biliary acids and the nutritional cholesterol. The hipolipemiantes treatments must be handled wisely, reason why we recommended the medical pursuit directly.

Treatment.

The fitoterapia aid of way important to control hiperlipidemias.

Hipolipidemiantes plants with mucílago and plants like Gugulón and Alcachofa can be recommended.

Plants with mucílago.

The rich fiber plants are also used in the treatments of hipercolesterolemia. Most interesting they are those composing of hidrosolubles fibers (mucílagos) that, when forming a voluminous gel has three types of action mainly:

• Engloban the fats in its structure.

• Disminuye the assimilation of nutritional fats,

• Bloquea partially the reabsorción of biliary acids (restrained of the enterohepático cycle) and therefore fecal elimination of the cholesterol.

Numerous therapeutic tests have proven the great benefit that contribute hidrosolubles fibers in the treatment of dislipidemias. Between the particularly rich hidrosolubles fiber plants, we emphasized ispágula (tegumento of the seed) The use of long term ispágula does not cause any undesired effect. It will only be necessary to consider that will be to avoid its use in intestinal case of obstruction.

Hipolipidemiantes plants.

We have in the therapeutic arsenal of the medicinal plants several plants that act favorably on lipidemia. Between these, two have an action to emphasize: the Gugulón (it draws resin from) and the Artichoke (leaf)

Useful valuations.

In order to evaluate the increase of the risks of cardiovascular pathologies, it is necessary to need as the cholesterol in circulating lipoproteins is distributed. For that reason, it will be necessary to consider the following valuations:

• total Cholesterol and triglicéridos.

• Apoproteína B (protein part of the LDL)

• Apoproteína A1 (protein part of the HDL)

• HDL cholesterol.

• LDL cholesterol.

Plants adapted for this disease.

Artichoke.

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