Understanding Cholesterol Types, Prevention, and Treatment

Mr.Ajinkya Avadhut Kudtarkar, College Director of Physical Education and Sports, VVM's Shree Damodar College of Commerce and Economics, Margao Goa. Ph.D. Scholar-SRTM University, Nanded, Maharastra, India

Mr.Suresh Nivartirao Jondhale, College Director of Physical Education and Sports, Saraswati Sangeet Kala, Mahavidyala, Latur,Maharastra-India

February 2021

Abstract

Obesity is the leading cause of mortality and non {communicable diseases. Cholesterol is identified as a major non-communicable disease that causes cardiovascular health issues. This study aims to get a deeper understanding of the meaning of Cholesterol, its types, Prevention and Treatment. The researcher reviewed different thematic papers on Cholesterol, for which the researcher used vital words like Cholesterol, Atherosclerosis, Lipids, Lipoproteins, Serum Cholesterol to identify other papers in this domain. Cholesterol is a precursor of bile acids and steroid hormones, and it is a fat-likes substance (Lipid) present in the cell membrane. It can be divided into different types such as Low-Density Lipoproteins (LDL), High-Density Lipoproteins (HDL), Very Low-Density lipoproteins (VLDL), and Triglycerides. However, there are many more classifications, but researchers have restricted these four types in this paper. Quitting smoking, engaging in physical activity, health check-ups; have been identified as primary preventive measures. Lifestyle changes such as eating a healthy diet and exercising, losing weight, medications with a consultation with supervisors were considered a treatment for high Cholesterol in reviewing the papers chosen by the researcher. Through this thematic evaluation, the researcher aimed to gain insight into Cholesterol's domain and understand its treatment methods.

Key Words: Cholesterol, High Density, lipoprotein, Low Density Lipoprotein, Very Low Density Lipoprotein, Triglycerides

1 Introduction

Obesity is defined as the accumulation of body fat, so that it has a negative implication on health. The underlying disease is the unfavourable positive energy balance and mass gain. Obese individuals will vary in the volume of excess fat, the division within the body, and related health concerns. The excess fat caused by weight gain increases the risk related to obesity and diseases caused by obesity. Fat surrounded at an abdominal level is as equally risky as extra fat percentage. Hence, to differentiate between those at more risk due to "abdominal fat distribution" or "android obesity." As known, "gynoid" fat division is less risky, in which fat is distributed around the body (WHO, 2000).

While obesity is itself a disease in its way, it is considered the main reason for other non-communicable diseases such as Non-insulin dependent diabetes mellitus, Cardiovascular disease, cancer, high blood pressure, and hyper-cholesterolemia. The harmful health effects caused through obesity are induced to a larger or smaller extent by weight, Fat distribution in the body, weight gain during childhood, and an inactive lifestyle (WHO, 2000).

purpose of this study is to understand cholesterol-types, prevention and treatment

2 Understanding Cholesterol

Cholesterol is a precursor of bile acids and steroid hormones, and it is a fat-like substance (Lipid) present in the cell membrane. It travels through the blood in distinct particles containing lipid and protein (Lipoproteins). Low-density lipoprotein, High-density Lipoproteins, and Very Low-density Lipoproteins are three major classes of lipoproteins(Natioanl cholesterol Education program,2002).

2.1 types of cholesterol

LDL Cholesterol forms a large part of total Serum cholesterol, approximately 60-70 per cent. It has a single apolipoprotein, namely apo B-100 (apo B). Major atherogenic lipoprotein is LDL cholesterol, and NCEP identifies it as major lipoprotein that needs to be lowered. This has become a major Lipoprotein cholesterol for reducing the risk of Cardiovascular disease (Natioanl cholesterol Education program,2002)..

HDL Cholesterol forms 20-30 per cent of total Serum cholesterol. Apo-I and Apo A-II are the significant HDL apolipoproteins. HDL Cholesterol and the risk of cardiovascular disease are inversely correlated. A low level of HDL signifies other atherogenic factors; some research suggests HDL protects against atherosclerosis development (Natioanl cholesterol Education program,2002)..

The Very Low-Density Lipoprotein contains 10-15 per cent of the total serum cholesterol, but it is part of triglyceride-rich lipoprotein. The major apolipoproteins of VLDL are apo B-100, apo Cs (C-I, C-II, and C-III), and apo E. Liver and precursors LDL Produces Very Low-Density Lipoprotein, Some types of VLDL, Specially VLDL remnants, appear to form atherosclerosis, Similar to LDL. Partially Degraded VLDL are part of VLDL remnants, and they are relatively enriched in cholesterol ester. IDL is one more type of lipoprotein that belongs to remnant lipoproteins; however, in Clinical practice, IDL is part of the LDL fraction (Natioanl cholesterol Education program,2002).

The last classification of lipoproteins, Chylomicrons, are triglycerides-rich lipoproteins; after a fat-containing meal, triglycerides are produced in the intestine and appear in the blood. In triglycerides, apo B-48 present instead of apo B-100 present in VLDL; other apolipoproteins of chylomicrons is the same as VLDL. Chylomicron remnants which are partially degraded chylomicrons carries some atherogenic potential(Natioanl cholesterol Education program,2002). Although LDL is the primary cause of atherogenesis requiring clinical management, some new studies show that VLDL and HDL also play an important role in atherogenesis. Therefore VLDL and HDL are the second most important in controlling a person at risk for Cardio Vascular diseases(Natioanl cholesterol Education program,2002).

2.2 Preventing Cholesterol

2.2.1 Quitting smoking as a preventive measure

Cigarette smoking has been established as a strong contributor to CHD risk and other sorts of CVD. The connection of smoking to CVD risked dose-dependent and observed in men and ladies. Observational data suggest that smoking cessation reduces the danger for CVD events which the decline in risk begins within months after quitting. 186 Randomized clinical trials of smoking cessation in primary prevention settings have revealed substantial reductions in risk for cardiac events in those that quit. Cigarette smoking features prominently within the risk assessment component of ATP III due to its CVD risks and, therefore, the substantial benefits of smoking cessation. Moreover, smokers benefit the maximum amount, if less, from LDL- lowering therapy as do non-smokers (Natioanl cholesterol Education program,2002).

2.2.2 Engaging in Physical Activity

Physical inactivity is related to increased risk for CHD. Conversely, physical activity favourably modifies several risk factors; Physical Activity helps to lower LDL,Triglycerids levels, Raise HDL and improve senstivity to insulin and lower vital sign. Evidence that physical activity can reduce risk for CHD comes from multiple observational studies. Therefore, physical inactivity is widely designated to be a serious risk factor for CHD, In ATP III, physical inactivity is also listed as a serious modifiable risk factor. The mechanisms whereby physical inactivity raises risk for CHD aren't fully understood and are probably multifactorial. Physical inactivity reduces caloric expenditure and doubtless contributes to obesity and to its associated lipid and nonlipid risk factors, as well on insulin resistance.240 Beyond its effects on standard risk factors, physical inactivity may have adverse effects on cardiovascular fitness and performance. Many of the damaging effects of a sedentary lifestyle that raise CHD risk are often inferred from the actions of increased physical activity, which include a reduction in insulin resistance, lowering of vital sign, reducing serum triglycerides, raising HDL cholesterol, and improving cardiovascular risk (Natioanl cholesterol Education program,2002)..

It has been suggested that a history of normal physical activity should count as a "negative risk factor," similarly to high HDL cholesterol. Although regular physical activity undoubtedly reduces baseline risk for CHD and should be encouraged, ATP III doesn't specifically count it as a negative risk factor for setting the LDL cholesterol level(Natioanl cholesterol Education program,2002)..

2.2.3 Health Check-Up

A fasting lipoprotein profile including major blood lipid fractions, i.e., total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride, should be obtained at least once every 5 years in adults age 20 and over. Since risk categories change slowly over time, the panel judged that lipoprotein measurement once every five years are adequate in otherwise low- risk persons. More frequent measurements are required for persons with multiple risk factors if the LDL level is merely slightly below the goal level, as will be described subsequently. If the testing opportunity is non-fasting, only the values for total cholesterol and HDL will be usable. In otherwise low-risk persons, further testing isn't required if the HDL-cholesterol level is > 40 mg/dL and total cholesterol is < 200 mg/dl(Natioanl cholesterol Education program,2002)..

2.3 Treatment of cholesterol

2.3.1 Adopting Healthful Lifestyle Habits.

A multifactorial lifestyle approach to reducing risk for CHD. This approach is designated therapeutic lifestyle changes ( TLC ) and includes the subsequent components.

• Reduced intakes of saturated fats and cholesterol
• Therapeutic dietary options for enhancing LDL lowering (plant stanols/sterols and increased viscous (soluble Fibre)
• Weight reduction Increased regular physical activity(Natioanl cholesterol Education program,2002)..

The major LDL - raising dietary constituents are saturated fat and cholesterol. A discount in intakes of those components is that the core of the TLC Diet. The scientific foundation for the connection between high intakes of saturated fat and increased LDL levels dates back several decades. It consists of several lines of evidence: observational studies, metabolic and controlled feeding studies, and clinical studies, including randomized clinical trials. The opposite major nutrients | unsaturated fats, protein, and carbohydrates | don't raise LDL cholesterol levels in developing an LDL - lowering diet(Natioanl cholesterol Education program,2002)..

Increased emphasis on weight reduction as a part of LDL- lowering therapy for overweight/obese persons who enter clinical guide-lines for cholesterol management. Indeed, weight control alone and lowering LDL cholesterolfavourably in uences all of the danger factors of metabolic syndrome(Natioanl cholesterol Education program,2002)..

Physical inactivity may be a significant risk factor for CHD. It raises CHD risk in several ways, notably by augmenting the lipid and non-lipid risk factors of metabolic syndrome. It further enhances risk by impairing cardio by a shift in emphasis on managing the metabolic, vascular fitness and coronary blood flow. Regular physical activity can help reverse these adverse effects. It can have favourable effects on metabolic syndrome and may reduce VLDL levels, raise HDL cholesterol and, lower LDL levels. Regular physical activity lowers vital sign and reduces insulin resistance. It also has been reported to scale back risk for CHD independently of ordinary risk factors(Natioanl cholesterol Education program,2002).

2.3.2 Medications

LDL cholesterol is the primary target of treatment in clinical lipid management. The utilization of therapeutic lifestyle changes (TLC), including LDL- lowering dietary options ( plant stanols/ sterols and increased viscous Fibre) will achieve the therapeutic goal in many persons. Nonetheless, some of the population whose short- and long-term risk for CHD would require LDL- lowering drugs to succeed in the prescribed goal for LDL cholesterol. The supply of HMG CoA reductase inhibitors (statins) allows attainment of the LDL goal in most higher-risk persons. Other agents|bile acid sequestrants, niacin, and a few fibrates|also can moderately lower LDL levels(Natioanl cholesterol Education program,2002)..

If TLC alone fails to realize the LDL cholesterol goal, consideration is often given to adding drug therapy. In such cases, the third visit of dietary therapy are going to be the visit to initiate drug treatment. When drugs are used, however, TLC also should be used concomitantly. Dietary therapy provides additional CHD risk reduction beyond drug efficacy(Natioanl cholesterol Education program,2002)..

3 Conclusion

Obesity is the leading cause of mortality and non {communicable diseases. Cholesterol is identified as a major non-communicable disease that causes cardiovascular health issues. Cholesterol is a precursor of bile acids and steroid hormones, and it is a fat-likes substance (Lipid) present in the cell membrane. It can be divided into different types such as Low-Density Lipoproteins (LDL), High-Density Lipoproteins (HDL), Very Low-Density lipoproteins (VLDL) and Triglycerides. Quitting smoking, engaging in physical activity, health check-ups; have been identified as primary preventive measures. Lifestyle changes such as eating a healthy diet and exercising, losing weight, and medications with supervisors were considered a treatment for High Cholesterol.

References

1 ) National Cholesterol Education Program (US). Expert Panel on Detection, Treatment of High Blood Cholesterol in Adults. (2002). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) (No. 2). The Program.

2) World Health Organization. (2000). Obesity: preventing and managing the global epidemic.