Signs

High blood fat (hyperlipidemia) progresses silently. When there are signs and symptoms suggestive of high blood fat, complications may already be present. Some common indicators include:

• Occasional chest pain that is short-lived and self-resolving without treatment but can recur at any time. There may also be a feeling of discomfort in the chest, such as heaviness, tightness, fullness, lasting from a few minutes to several tens of minutes. The pain often occurs with exertion and decreases with rest, possibly accompanied by or without shortness of breath, and may radiate to one or both arms, the back, neck, jaw, or even the stomach area.
• Abnormal signs such as spontaneous sweating, nausea, headaches, dizziness, restlessness, shortness of breath, palpitations, obesity with decreased work capacity, and frequent fatigue.
• In some cases, xanthomas (yellowish skin nodules): small, smooth-surfaced, yellow bumps on the skin, commonly found around the eyes, elbows, thighs, heels, back, and chest, about the size of a fingertip, not painful or itchy.

When there are suspected signs of hyperlipidemia, lipid profile tests should be conducted for a definitive diagnosis, with results indicating:

• Increased total cholesterol.
• Increased LDL-cholesterol.
• Increased triglycerides.
• Decreased HDL-cholesterol.

Causes

Dietary Lipid Increase:

Lipid levels in the blood begin to rise 2-3 hours after consuming a high-fat meal, peak at 4-6 hours, and return to normal by the ninth hour.

The degree and duration of lipid increase depend on various factors: type of fat (vegetable oils are absorbed faster than animal fats), time for fat to leave the stomach, intensity of intestinal movements, bile secretion amount, pancreatic and intestinal lipase activity, initial blood lipid levels, etc.

Once blood lipid levels increase, additional fat intake does not significantly elevate them further due to the self-regulatory mechanism of lipid absorption inhibition in the intestines, activation of fat deposition in lung tissues, stimulation of the reticuloendothelial system causing increased hormone and heparin secretion. Any disruption in this chain can cause a lipid regulation disorder.

Lipid Increase Due to Retention:

Reduced lipoprotein lipase activity due to increased enzyme inhibitors (protamine, bile acids, NaCl) or decreased heparin secretion (as seen in atherosclerosis) results in reduced triglyceride hydrolysis (in the form of chylomicrons), causing lipid increase.

In nephrotic syndrome, lipid increase is due to fat metabolism inhibitors; additionally, plasma albumin reduction (due to severe proteinuria) decreases the ability to bind to free fatty acids, leading to inhibited fat metabolism and increased lipids. Lipid increase after hemorrhage follows a similar mechanism. Injecting albumin in nephrotic patients can stop lipid increase.

Lipid Increase Due to Mobilization:

Lipid increase due to mobilization can be caused by: reduced glycogen reserves (starvation), stress, heavy labor, sympathetic nervous system stimulation, increased hormone secretion (catecholamines, ACTH, STH, thyroxine), diabetes (glucose not utilized, increased lipid metabolism, blood lipid levels can reach 1,000 – 2,800 mg/100ml).

Injecting glucose to raise blood sugar can increase triglyceride synthesis in fat tissues, thereby limiting fat metabolism and stopping mobilization-induced lipid increase.

Nutrition for People with High Blood Fat

People with high blood fat need to strictly control their diet. They should eat foods with low cholesterol, such as green vegetables, products made from beans, and lean meat. Green vegetables high in fiber should be prioritized as they reduce intestinal cholesterol absorption.

• Avoid late-night meals high in protein as they are hard to digest and can lead to cholesterol deposits in the arteries, causing atherosclerosis.
• Eat low-salt foods as they are beneficial for heart health. Avoid foods high in fat and opt for low-fat foods such as fish, tofu, and soybeans.
• Consume foods that help reduce blood fat, such as ginger, soy products, mushrooms, onions, tea, and corn oil.

To manage high blood cholesterol, dietary adjustments are the top priority.

Treatment

Adjust Diet and Lifestyle: Increase physical activity, reduce fat intake, avoid animal organs, replace animal fats with vegetable oils, consume high-fiber foods, and eat freshwater fish.

Medication: One of the statins may be used (starting with a low dose). The dose can be doubled if the effect is not achieved after 4-6 weeks of treatment.

Lipid disorder treatment in diabetic patients should prioritize lifestyle changes combined with statins to reduce LDL-cholesterol and fibrates to reduce triglycerides. Statins should be used for all diabetic patients over 40 years old, even if lipid levels are normal. Metformin, which reduces triglycerides, may be preferred over other drugs for diabetic patients. Patients with very high triglycerides and poorly controlled blood sugar should consider insulin treatment for better blood sugar control compared to oral medications. Lipid disorder treatment in patients with renal failure or chronic liver disease requires managing the underlying condition and lipid disorder. Lipid disorders in hypothyroid patients need thyroid hormone treatment. Reduce or stop lipid-lowering drugs when the underlying issue is resolved.

PGS.TS. NGUYỄN HOÀI NAM
(Theo Cổng TTĐT Bệnh viện Bạch Mai)