High density lipoproteins circulate in the blood plasma. Their main property is anti-atherogenic. It is these lipoproteins that protect blood vessels from the deposition of atherosclerotic plaques on their walls. For this property, they (HDL) are called good cholesterol, as they also remove excess cholesterol, transporting it to the liver. Some patients worry that the results of blood tests HDL cholesterol elevated. This is especially true for people with problems in the cardiovascular system, in particular, those with a high risk of developing atherosclerosis.

HDL provide the processing and removal of fats from the body, so they are called good cholesterol

The content of LDL and total cholesterol is also evaluated. It is important to know due to which fractions of lipoproteins the level of cholesterol is increased, or what it consists of at its normal numbers.

To determine the value of both cholesterol and lipoproteins of different densities, blood is taken from a vein in the morning, on an empty stomach. According to the results laboratory tests a lipid profile is formed containing the concentration in the blood of total cholesterol, high, low and very low density lipoproteins, as well as triglycerides. All indicators are analyzed first independently of each other, and then in aggregate.

Differences between HDL, LDL and VLDL

To understand the topic, first of all, it is worth learning what atherosclerosis is. Scientifically, this is a vascular disease caused by a violation of lipid and protein metabolism, which is accompanied by the accumulation of cholesterol and some fractions of lipoproteins in the lumen of the vessels in the form of atheromatous plaques. Simply put, these are deposits of cholesterol and some other substances in the vessel wall, which reduce its throughput. Consequently, blood flow becomes worse. Up to a complete blockage. In this case, the blood does not enter the organ or limb and necrosis develops - necrosis.

Deposits of cholesterol and lipids in the walls of blood vessels lead to atherosclerosis.

All lipoproteins are spherical formations of varying density, freely circulating in the blood. Very low-density lipids are so large (of course, on a cell scale) that they are unable to penetrate the vessel wall. Accumulation does not occur and the atherosclerosis described above does not develop. But it is worth remembering that if they are increased, then the development of pancreatitis, a disease of the pancreas, is possible.

Just low-density lipids are able to penetrate the vessel wall. Moreover, when the body tissues need them, lipids pass through the artery further, as they say, “at the address”. If there is no need, and the concentration in the blood is high, then LDL penetrate the wall and remain in it. Further, undesirable oxidative processes occur, which are the cause of atherosclerosis.

HDL is the smallest of the listed lipids. Their advantage lies in the fact that they can easily both penetrate the vessel wall and leave it easily. In addition, they have an antioxidant effect, inhibiting the process of transformation of low-density lipids into atherosclerotic plaques.

LDL cholesterol is considered “bad”, because when it is in excess, plaques form in the walls of blood vessels, which can limit the movement of blood through the vessel, which threatens atherosclerosis and significantly increases the risk of heart disease ( coronary disease, heart attack) and stroke

Now it becomes clear why high-density lipids are usually called good or good cholesterol. It also becomes clear why it is worth assessing not only total cholesterol, but also its fractions.

However, do not panic when reading the above mechanism. This does not mean that plaques are constantly formed in the vessels, and their subsequent blockage is only a matter of time. Normally, the mechanisms of lipid regulation work constantly. Only with age, in the presence of an unhealthy lifestyle or with various pathologies this process is violated. Accumulation does not happen all at once, in a matter of minutes or hours, but rather for a long time. But you should not delay treatment.

Reasons for the increase and decrease in HDL

We can safely say that a low level of these lipoproteins is more dangerous than a high one. If in the analysis blood HDL increased, their increase is regarded as protection against atherosclerosis, an anti-atherogenic factor. Undoubtedly, under certain circumstances, overestimated figures of this indicator can cause concern, with too high figures, high density lipoproteins lose their protective properties.

An increase in HDL levels is not dangerous!

The reasons for increasing the level of this fraction of lipoproteins are as follows:

• Genetic mutations that result in overproduction or decreased excretion of good cholesterol.
• Chronic alcoholism, especially at the stage of liver cirrhosis.
• Primary biliary cirrhosis.
• Hyperthyroidism.
• Taking certain medications: insulin, glucocorticoids.
• Familial hyperalphapipoproteinemia. It is not accompanied by any symptoms, nothing bothers the patient, it is detected as an accidental finding.
• Perhaps an increase in the rate in women preparing to become a mother. This is especially true for later dates pregnancy, when the rate can almost double.

High cholesterol during pregnancy is due to the fact that in the body there is an increase in lipid metabolism and the synthesis of hormones by the adrenal glands.

Causes reduced content HDL:

• Diabetes.
• Hyperlipoproteinemia type IV.
• Diseases of the kidneys and liver.
• Acute viral and bacterial infections.

You need to understand that one indicator of HDL is not proof of one or the state of the body. It can only be taken into account in comparison with the level of total cholesterol and LDL.

This is expressed, first of all, in the so-called atherogenic coefficient. It is calculated according to the following formula: high-density cholesterol is subtracted from total cholesterol, and then the resulting figure is divided again by HDL. The resulting coefficient is compared with normal values. On average, it should not be higher than 2.5-3.5 for men (depending on age) and no higher than 2.2 for women. The higher the ratio, the higher the risk of coronary heart disease. By including simple mathematical logic, one can understand that the higher the total cholesterol and the less lipoproteins, the more the value of the coefficient will increase; and vice versa. Which again proves the protective function of high-density proteins. Therefore, if both cholesterol and HDL are elevated, this means that in general the coefficient will be low, but it is worth thinking about reducing the cholesterol content in the blood. If only HDL is elevated, this means that there is no cause for concern.

It is impossible to correlate proteins of high and low density through any coefficient. They are evaluated independently of each other.

What can be done

If the reasons for the increase in high-density lipoproteins remain unknown and there is concern for your health, then you should visit your doctor. This is true if blood was donated, for example, as part of a medical examination or for any other reason not directly related to going to the doctor about problems with the cardiovascular system.

Do not worry if the doctor prescribes additional methods of examination. They are needed only for a comprehensive study of the causes of changes in blood parameters.

Two weeks prior to the study, lipid-lowering drugs should be discontinued unless the goal is to determine the effect of therapy with these drugs in the analysis.

The doctor's recommendations will contain simple, but very important notes. To begin with, you should limit the intake of fats, in particular, saturated fats contained in butter, lard, lamb fat, margarine and a number of other products. They should be replaced with polyunsaturated fats, which include olive oil, salmon fish and others. If you are overweight, you should lose it. This is achieved by adjusting nutrition and increasing physical activity. Try to stop drinking too much alcohol and stop smoking completely.

In the event that the indicators go far beyond allowable norms, then it can be assigned drug therapy. But its effectiveness will be many times higher also if the above recommendations are followed.

An increase in the level of cholesterol in the blood, as well as its individual fractions, at first glance, may seem dangerous. But do not worry and panic ahead of time.

HDL is called good cholesterol. Unlike low density lipoproteins, these particles have anti-atherogenic properties. Increased amount HDL in the blood reduces the likelihood of atherosclerotic plaques, cardiovascular diseases.

High Density Lipoprotein Features

They have a small diameter of 8-11 nm, a dense structure. HDL cholesterol contains a large amount of protein, its core consists of:

• protein - 50%;
• phospholipids - 25%;
• cholesterol esters - 16%;
• triglycerols - 5%;
• free cholesterol (cholesterol) - 4%.

LDL deliver cholesterol produced by the liver to tissues and organs. There it is spent on the creation of cell membranes. Its residues collect HDL high density lipoproteins. In the process, their shape changes: the disk turns into a ball. Mature lipoproteins transport cholesterol to the liver, where it is processed and then excreted from the body by bile acids.

A high level of HDL significantly reduces the risk of atherosclerosis, heart attack, stroke, ischemia internal organs.

Preparation for the delivery of a lipidogram

• Blood for research is taken in the morning from 8 to 10 o'clock.
• 12 hours before the test, you can not eat, ordinary water you can drink.
• A day before the study, you can not starve or, on the contrary, overeat, drink alcohol, products containing it: kefir, kvass.
• If the patient is taking medications, vitamins, dietary supplements, this should be reported to the doctor before the procedure. Perhaps he will advise you to completely stop taking the drugs 2-3 days before the analysis or postpone the study. Strongly distort the results of the anabolic lipid profile, hormonal contraceptives, non-steroidal anti-inflammatory drugs.
• It is undesirable to smoke immediately before the test.
• 15 minutes before the procedure, it is advisable to relax, calm down, restore breathing.

What influences HDL test results? The accuracy of the data can be affected by physical activity, stress, insomnia, extreme rest experienced by the patient on the eve of the procedure. Under the influence of these factors, cholesterol levels can increase by 10-40%.

An analysis for HDL is prescribed:

• Every year - people suffering diabetes of any type who have had a heart attack, stroke, who have coronary artery disease, atherosclerosis.
• Once every 2-3 years, studies are carried out with a genetic predisposition to atherosclerosis, heart disease.
• Once every 5 years, it is recommended to take an analysis to persons over 20 years of age in order to early detection atherosclerosis of blood vessels, diseases of the heart apparatus.
• 1 time in 1-2 years it is desirable to control lipid metabolism with increased total cholesterol, unstable blood pressure, chronic hypertension, obesity.
• 2-3 months after the start of conservative or drug treatment, a lipid profile is carried out to check the effectiveness of the prescribed treatment.

Norm HDL

For HDL, the limits of the norm are set taking into account the gender and age of the patient. The concentration of a substance is measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

Norm HDL mmol / l

Age (years)	Women	Men
5-10	0,92-1,88	0,96-1,93
10-15	0,94-1,80	0,94-1,90
15-20	0,90-1,90	0,77-1,61
20-25	0,84-2,02	0,77-1,61
25-30	0,94-2,13	0,81-1,61
30-35	0,92-1,97	0,71-1,61
35-40	0,86-2,11	0,86-2,11
40-45	0,86-2,27	0,71-1,71
45-50	0,86-2,24	0,75-1,64
50-55	0,94-2,36	0,71-1,61
55-60	0,96-2,34	0,71-1,82
60-65	0,96-2,36	0,77-1,90
65-70	0,90-2,46	0,77-1,92
> 70	0,83-2,36	0,84-1,92

The norm of HDL in the blood, mg / dl

To convert mg/dl to mmol/l use a factor of 18.1.

Lack of HDL leads to a predominance of LDL. Fatty plaques change the vessels, narrowing their lumen, impair blood circulation, increasing the likelihood of dangerous complications:

• Narrowed vessels impair the blood supply to the heart muscle. She doesn't get enough nutrients, oxygen. There is angina pectoris. The progression of the disease leads to a heart attack.
• Atherosclerotic plaque damage carotid artery, small or large vessels of the brain disrupts blood flow. As a result, memory deteriorates, behavior changes, and the risk of stroke increases.
• Atherosclerosis of the vessels of the legs leads to lameness, the appearance of trophic ulcers.
• Cholesterol plaques that affected large arteries kidneys, lungs cause stenosis, thrombosis.

Causes of fluctuations in HDL levels

An increase in the concentration of high density lipoproteins is detected quite rarely. It is believed that the more cholesterol of this fraction is contained in the blood, the lower the risk of atherosclerosis, heart disease.

If HDL is increased significantly, there are serious lipid metabolism failures, the cause is:

• genetic diseases;
• chronic hepatitis, cirrhosis of the liver;
• acute or chronic liver toxicity.

To confirm the diagnosis, diagnostics are carried out, when a disease is detected, treatment begins. There are no specific measures or drugs that artificially lower the level of beneficial cholesterol in the blood.

Cases where HDL is lowered are more common in medical practice. Deviations from the norm cause chronic diseases and nutritional factors:

• celiac disease, hyperlipidemia;
• dysfunction of the liver, kidneys, thyroid gland that cause hormonal disorders;
• excess dietary intake of exogenous cholesterol;
• smoking;
• acute infectious diseases.

Decreased HDL levels may indicate atherosclerotic lesion vessels, reflect the degree of risk of developing coronary artery disease.

To assess possible risks, the ratio of high-density lipoproteins and total cholesterol is taken into account.

When analyzing indicators of HDL, it is revealed possible risks cardiovascular diseases:

• Low - the probability of atherosclerotic vascular lesions, the development of angina pectoris, ischemia is minimal. High concentration good cholesterol Provides protection against heart vascular pathologies.
• Moderate - requires monitoring of lipid metabolism, measurement of the level of apolipoprotein B.
• Maximum permissible - characterized by a low level of good cholesterol, the development of atherosclerosis and its complications can be prevented.
• High - low HDL with elevated levels of total cholesterol indicates an excess of LDL, VLDL, triglycerides. This condition threatens the heart, blood vessels, increases the possibility of developing diabetes due to insulin insensitivity.
• Dangerous - means that the patient already has atherosclerosis. Such abnormally low rates may indicate rare genetic mutations in lipid metabolism, for example, Tangier's disease.

It should be added that during the studies, entire groups of people with low levels of beneficial lipoproteins were identified. However, this was not associated with any risk of cardiovascular disease.

How to increase good cholesterol

A healthy lifestyle plays the main role in increasing the indicators of useful cholesterol:

• Quitting smoking causes an increase in HDL by 10% within a month.
• Increasing physical activity also increases good lipoprotein levels. Swimming, yoga, walking, running, gymnastics in the morning restore muscle tone, improve blood circulation, enrich the blood with oxygen.
• A balanced, low-carbohydrate diet helps to maintain normal levels of good cholesterol. With a lack of HDL, the menu should include more products containing polyunsaturated fats: sea fish, vegetable oils, nuts, fruits, vegetables. Don't forget the proteins. They provide the body with the energy it needs. Enough protein and a minimum of fat contains dietary meat: chicken, turkey, rabbit.
• Restore normal ratio HDL and LDL cholesterol will help the diet. Eating 3-5 times a day in small portions improves digestion, the production of bile acids, accelerates the removal of toxins and toxins from the body.
• With obesity, metabolic disorders, reducing bad cholesterol and increasing the level of beneficial lipoproteins will help to refuse fast carbohydrates: sweets, confectionery, fast food, sweet pastries.

• Fibrates increase HDL levels by reducing harmful cholesterol in peripheral tissues. Active substances restore lipid metabolism, improve blood vessels.
• Niacin (nicotinic acid) is the main element of many redox reactions and lipid metabolism. In large quantities, it increases the concentration of useful cholesterol. The effect is shown in some days after the beginning of reception.
• Statins to increase good cholesterol are prescribed along with fibrates. Their intake is relevant for abnormally low HDL levels, when hypolipidemia is caused by genetic disorders.
• Policonazole (BAA) is used as a food supplement. Reduces total cholesterol, LDL, increases the concentration of high density lipoproteins. Does not affect triglyceride levels.

Elimination of risk factors, rejection bad habits, compliance with the recommendations restores the metabolism of fats, delays the development of atherosclerosis, improves the patient's condition. The quality of life of the patient does not change, and the threat of cardiovascular complications becomes minimal.

Literature

1. Kimberly Holland. 11 Foods to Increase Your HDL, 2018
2. Fraser, Marianne, MSN, RN, Haldeman-Englert, Chad, MD. Lipid Panel with Total Cholesterol: HDL Ratio, 2016
3. Ami Bhatt, MD, FACC. Cholesterol: Understanding HDL vs. LDL, 2018

Last updated: February 16, 2019

It is known that enough level HDL is essential for normal function of cardio-vascular system. There are circumstances when “good” cholesterol rises against the background of dangerous diseases.

Treatment of almost all cardiovascular pathological conditions does not do without assessing the concentration of various fractions of cholesterol. Sometimes an analysis of blood lipid parameters shows: What does it mean?

A substantiated fact is that high density lipoproteins prevent the development of atherosclerosis. But the predominance increases the likelihood of heart attacks, strokes, disrupts the function nervous system. At the same time, a change in HDL levels above normal can indicate serious health problems.

Cholesterol is known to play a number of important roles in the body. Without this substance, the function of any living cell is impossible. Cholesterol is involved in the synthesis of certain hormones (testosterone, progesterone, estrogen, cortisol), ergocalciferol (vitamin D), and bile acids. At the same time, there is a lot of information about negative impact on the body's cholesterol.

Causes negative influence cholesterol lie in its structure and concentration in the blood. The substance is not homogeneous in composition, but includes high density lipoproteins, low and very low density lipoproteins. In addition, triglycerides and cholesterol oxidation products, oxysterols, can circulate in the blood. It has been established that LDL, oxysterols and triglycerides are active participants the formation of atheromatous plaques.

"Good" and "bad" cholesterol

High-density lipoproteins carry cholesterol to the liver for further processing and excretion from the body. The higher the level of HDL, the more effectively they perform their function, preventing the deposition of atheromatous plaques inside the vessels. This means that "good" cholesterol prevents the development of atherosclerosis.

The situation is different with low-density lipoproteins. Their structures transport cholesterol to cells and vessels. LDL is also the starting material for the synthesis of hormones, vitamin D. If the level of low-density lipoprotein becomes higher than normal, excess cholesterol particles begin to invade the arterial walls, forming atherosclerotic plaques. This circumstance leads to a decrease in the lumen of the vessels and the development ischemic pathologies(heart attack, stroke).

"Good" and "bad" cholesterol in the body are closely related to each other. High molecular weight lipoproteins carry out the capture and excretion of cholesterol derived from LDL. If the level of "bad" cholesterol in the blood becomes below normal, it ceases to be supplied with food, and the liver begins to actively synthesize it. A decrease in the concentration of HDL in such a situation leads to the development of atherosclerosis.

Role of triglycerides

Triglycerides, being a source of energy in the body, along with low density lipoproteins, can influence the formation of atherosclerotic plaques. This circumstance occurs when the concentration of fats in the blood is higher than normal, and the “good” cholesterol, due to its low content, ceases to perform the function of carrying LDL.

An increase in the amount of triglycerides occurs with excessive consumption of foods rich in animal fats. The use of drugs containing hormonal agents, and large quantities ascorbic acid, increases the level of triglycerides in the blood, provoking the development of thrombosis, atherosclerosis.

The danger of oxysterols

Oxysterols are intermediate structures that are formed during the synthesis of bile acids, steroid hormones. However, oxysterols, which enter the body with food, are of particular danger to blood vessels. These compounds are capable of triggering the formation of atherosclerotic plaques. Oxysterols are present in large amounts in egg yolks, frozen meat, fish, as well as milk powder, melted butter.

Research procedure

Usually, a blood test for cholesterol fractions and triglycerides is prescribed by a doctor to find out the cause of high blood pressure, in cardiovascular endocrine pathologies, during application hormonal drugs. It would be useful to have a cholesterol test for men over the age of 35, and for women over 40.

Before the study, it is not recommended to eat food for several days, rich in fat. The analysis is carried out on an empty stomach. Physical activity, stress and smoking before taking blood for cholesterol distorts the results of the study.

Substance concentration assessment

To determine how much cholesterol levels negatively affect a person's health, it is necessary to analyze several parameters. This is the level of total cholesterol, triglycerides, as well as the concentration of HDL and LDL in the blood. For men and women of different age groups performance standards will vary.

The interpretation and evaluation of data obtained from a blood test for various lipid fractions is carried out by a doctor, taking into account the age and gender of the person. There are certain norms for the content of total cholesterol, LDL, HDL, triglycerides for women and men. Also, the decoding of the analysis should include an atherogenic index. This indicator means what is the ratio between high and low density lipoproteins. In other words, how much "good" cholesterol prevails over "bad".

Sometimes, lipidogram indicators (blood test for various fat fractions) change for the worse under the influence of physiological factors. In men, cholesterol and triglyceride levels are more affected by age. In women, indicators of "bad" cholesterol and lipids are increased during pregnancy, after the onset of menopause. Low-density lipoproteins and triglycerides are above normal with stressful situations, increased physical activity.

total cholesterol

The analysis of blood lipids must necessarily include information on total cholesterol. The norms of this indicator vary depending on the age and gender of the person. usually elevated in the elderly and can reach 6.5-7 mmol/liter. Women tend to have higher cholesterol levels than the opposite sex. A sharp decrease in cholesterol concentration is observed in postoperative period, with myocardial infarction, severe bacterial infections.

LDL indicators

The next integral indicator, which includes the decoding of the lipid profile, is low-density lipoproteins. With an increased concentration of LDL, the risk of developing severe vascular pathologies, ischemia and atherosclerosis increases.

In men, the norms for the content of low-density lipoproteins up to the age of thirty are lowered in comparison with the data of their peers of the opposite sex. This indicator ranges from 1.6 mmol / liter in boys 5-10 years of age to 4.27 mmol / liter in thirty-year-old men. In women, LDL levels gradually increase from 1.8 mmol / liter at the age of five to 4.25 mmol / liter at 30 years of age.

Then, up to the age of fifty, the LDL level is slightly higher in men than in women of the same period of life and reaches 5.2 mmol / liter. Maximum concentrations"Bad" and are considered within the normal range up to 5.7 mmol / liter at the age of seventy.

HDL concentration

In the blood test for cholesterol, an indicator of the level of high density lipoprotein should be reflected. As a rule, the concentration of HDL is relatively low and should be in the range of 0.7-1.94 mmol / liter for men or women different ages. Low level lipoproteins almost always means that the risk of developing pathologies of the heart and blood vessels is increased.

It is believed that the higher the high-density lipoprotein index, the better it will reflect on the state of human health. Really, high level HDL prevents the formation of atherosclerotic plaques. However, high-density lipoprotein data may indicate serious diseases.

It is known that hepatitis chronic stage, biliary cirrhosis of the liver, prolonged intoxication, prolonged alcohol intake can increase the concentration of high density lipoproteins. That is why, when deciphering the lipid profile, it is important to pay attention to the limiting values ​​of HDL.

Atherogenic coefficient

According to atherogenicity, it is possible to assess the real risks of atherosclerosis. The atherogenic coefficient is defined as the difference between total cholesterol and HDL concentration divided by the amount of high density lipoprotein. The higher the atherogenicity, the greater the likelihood of a person developing vascular damage, heart attacks, strokes, and hypertension.

Permissible limits of atherogenicity for young people range from 3. After thirty years, atherogenicity can reach 3.5, and at an older age - 7.0.

Triglycerides

Vessels are at serious risk of developing atherosclerosis if the level of triglyceride concentration in the blood is elevated. In women, this indicator normally varies from 0.4 to 1.6 mmol / liter, and in men it should be in the range of 0.5-2.8 mmol / liter. The level of triglycerides is lowered in violation of the liver, pulmonological diseases, malnutrition. Causes of elevated triglyceride concentrations may be associated with diabetes mellitus, viral or alcohol defeat liver.

How to improve your lipid profile

Evaluation of indicators of various fractions of cholesterol allows the doctor to prevent the development of atherosclerosis, hypertension, prevent the occurrence of heart attacks and strokes. There are several ways to improve lipid profile data. First of all, you should refuse nicotine addiction, do not abuse alcoholic drinks, reasonable approach to physical activity. It is important to eat large amounts of pectins, a minimum of fats and carbohydrates.

To reduce atherogenicity, a doctor may prescribe special medications: statins, fibrates, antioxidants, as well as agents for the normalization of liver function. Sometimes, in order to reduce the level of "bad" cholesterol, it is necessary to stop taking medications containing hormones. Normalization of the psycho-emotional state also contributes to the improvement of the lipid profile. It is important to be responsible for your health and periodically, together with your doctor, conduct a concentration assessment.

Lipoproteins (lipoproteins) of high and low density in the blood: what is it, normal, increase

Lipoproteins are complex protein-lipid complexes that are part of all living organisms and are essential integral part cell structures. Lipoproteins perform a transport function. Their content in the blood is an important diagnostic test that indicates the degree of development of diseases of the body systems.

This is a class of complex molecules, which can simultaneously include free, fatty acid, neutral fats, phospholipids and in various quantitative ratios.

Lipoproteins deliver lipids to various fabrics and organs. They consist of non-polar fats located in the central part of the molecule - the core, which is surrounded by a shell formed from polar lipids and apoproteins. The similar structure of lipoproteins explains their amphiphilic properties: simultaneous hydrophilicity and hydrophobicity of the substance.

Functions and meaning

Lipids play important role in the human body. They are found in all cells and tissues and are involved in many metabolic processes.

lipoprotein structure

• Lipoproteins are the main transport form of lipids in the body.. Since lipids are insoluble compounds, they cannot fulfill their purpose on their own. Lipids bind in the blood to proteins - apoproteins, become soluble and form a new substance, called lipoprotein or lipoprotein. These two names are equivalent, abbreviated - LP.

Lipoproteins occupy a key position in the transport and metabolism of lipids. Chylomicrons transport fats that enter the body with food, VLDL deliver endogenous triglycerides to the site of disposal, cholesterol enters cells with the help of LDL, HDL have antiatherogenic properties.

• Lipoproteins increase the permeability of cell membranes.
• LP, the protein part of which is represented by globulins, stimulate the immune system, activate the blood coagulation system and deliver iron to the tissues.

Classification

LP of blood plasma is classified by density(using the ultracentrifugation method). The more lipids are contained in the LP molecule, the lower their density. Allocate VLDL, LDL, HDL, chylomicrons. This is the most accurate of all. existing classifications LP, which was developed and proven using an accurate and rather painstaking method - ultracentrifugation.

The size of the LP is also heterogeneous. The largest molecules are chylomicrons, and then in decreasing size - VLDL, HDL, LDL, HDL.

Electrophoretic classification LP is very popular among clinicians. Using electrophoresis, the following classes of LP were identified: chylomicrons, pre-beta lipoproteins, beta lipoproteins, alpha lipoproteins. This method based on introduction into a liquid medium active substance using galvanic current.

Fractionation LP is carried out in order to determine their concentration in blood plasma. VLDL and LDL are precipitated with heparin, while HDL remains in the supernatant.

Kinds

Currently allocate the following types lipoproteins:

HDL (high density lipoprotein)

HDL transports cholesterol from body tissues to the liver.

1. An increase in HDL in the blood is noted with obesity, fatty hepatosis and biliary cirrhosis, alcohol intoxication.
2. The decrease in HDL occurs when hereditary disease Tangier, caused by the accumulation of cholesterol in the tissues. In most other cases, a decrease in the concentration of HDL in the blood is a sign.

HDL levels are different for men and women. In males, the LP value of this class ranges from 0.78 to 1.81 mmol / l, the norm for women HDL is from 0.78 to 2.20, depending on age.

LDL (low density lipoprotein)

LDL are carriers of endogenous cholesterol, triglycerides and phospholipids from the liver to tissues.

This class of LP contains up to 45% cholesterol and is its transport form in blood. LDL is formed in the blood as a result of the action of the enzyme lipoprotein lipase on VLDL. With its excess, they appear on the walls of the vessels.

Normally, the amount of LDL is 1.3-3.5 mmol / l.

• The level of LDL in the blood rises with hypothyroidism, nephrotic syndrome.
• Reduced LDL levels are observed with inflammation of the pancreas, hepatic-renal pathology, acute infectious processes, pregnancy.

infographics (click to enlarge) - cholesterol and LP, role in the body and norms

VLDL (very low density lipoproteins)

VLDL are formed in the liver. They carry endogenous lipids synthesized in the liver from carbohydrates into tissues.

These are the largest LPs, second in size only to chylomicrons. They are more than half made up of triglycerides and contain a small amount of cholesterol. With an excess of VLDL, the blood becomes cloudy and acquires a milky hue.

VLDL is a source of "bad" cholesterol, from which plaques form on the vascular endothelium. Gradually plaques increase, joins with the risk of acute ischemia. VLDL is elevated in patients with kidney disease.

Chylomicrons

Chylomicrons are absent from the blood healthy person And appear only in violation of lipid metabolism. Chylomicrons are synthesized in mucosal epithelial cells small intestine. They deliver exogenous fat from the intestines to peripheral tissues and liver. Most of the transported fats are triglycerides, as well as phospholipids and cholesterol. In the liver, under the influence of enzymes, triglycerides break down and fatty acids are formed, some of which are transported to the muscles and adipose tissue, and the other part binds to blood albumin.

what do major lipoproteins look like

LDL and VLDL are highly atherogenic- containing a lot of cholesterol. They penetrate the wall of the arteries and accumulate in it. When metabolism is disturbed, the level of LDL and cholesterol rises sharply.

The most safe against atherosclerosis are HDL. Lipoproteins of this class remove cholesterol from cells and contribute to its entry into the liver. From there, it enters the intestines with bile and leaves the body.

Representatives of all other classes of LP deliver cholesterol to cells. Cholesterol is a lipoprotein that is part of the cell wall. It is involved in the formation of sex hormones, the process of bile formation, the synthesis of vitamin D, which is necessary for the absorption of calcium. Endogenous cholesterol is synthesized in the liver tissue, adrenal cells, intestinal walls, and even in the skin. Exogenous cholesterol enters the body along with animal products.

Dyslipoproteinemia - a diagnosis in violation of lipoprotein metabolism

Dyslipoproteinemia develops when two processes are disturbed in the human body: the formation of LP and the rate of their excretion from the blood. H violation of the ratio of LP in the blood is not a pathology, but a factor in the development of a chronic disease, in which the arterial walls are compacted, their lumen narrows and the blood supply to the internal organs is disturbed.

With an increase in the level of cholesterol in the blood and a decrease in the level of HDL, atherosclerosis develops, leading to development of deadly diseases.

Etiology

Primary dyslipoproteinemia is genetically determined.

Causes secondary dyslipoproteinemias are:

1. hypodynamia,
2. Diabetes,
3. Alcoholism,
4. kidney dysfunction,
5. hypothyroidism,
6. hepatic-renal failure,
7. Long-term use of certain medications.

The concept of dyslipoproteinemia includes 3 processes - hyperlipoproteinemia, hypolipoproteinemia, alipoproteinemia. Dyslipoproteinemia is quite common: every second inhabitant of the planet has similar changes in the blood.

Hyperlipoproteinemia is an increased content of LP in the blood due to exogenous and endogenous causes. The secondary form of hyperlipoproteinemia develops against the background of the underlying pathology. At autoimmune diseases LP are perceived by the body as antigens, to which antibodies are produced. As a result, antigen-antibody complexes are formed, which are more atherogenic than the drugs themselves.

Alipoproteinemia is a genetically determined disease with autosomal dominant inheritance. The disease is manifested by an increase in the tonsils with an orange coating, hepatosplenomegaly, lymphadenitis, muscle weakness, decreased reflexes, hyposensitivity.

Hypolipoproteinemia — low blood levels of lipoproteins, often asymptomatic. The causes of the disease are:

1. Heredity,
2. malnutrition,
3. Passive lifestyle,
4. Alcoholism,
5. Pathology of the digestive system,
6. Endocrinopathy.

Dyslipoproteinemias are: organ or regulatory , toxigenic, basal - a study of the level of LP on an empty stomach, induced - a study of the level of LP after a meal, drugs or exercise.

Diagnostics

It is known that excess cholesterol is very harmful for the human body. But the lack of this substance can lead to dysfunction of organs and systems. The problem lies in hereditary predisposition as well as lifestyle and nutritional habits.

Diagnosis of dyslipoproteinemia is based on the history of the disease, complaints of patients, clinical signs - the presence of xanthoma, xanthelasma, lipoid arch of the cornea.

The main diagnostic method of dyslipoproteinemia is a blood test for lipids. Determine the coefficient of atherogenicity and the main indicators of the lipid profile - triglycerides, total cholesterol, HDL, LDL.

Lipidogram - method laboratory diagnostics, which reveals lipid metabolism disorders leading to the development of diseases of the heart and blood vessels. Lipidogram allows the doctor to assess the patient's condition, determine the risk of developing atherosclerosis of the coronary, cerebral, renal and hepatic vessels, as well as diseases of the internal organs. Blood is taken in the laboratory strictly on an empty stomach, at least 12 hours after the last meal. The day before the analysis exclude the intake of alcohol, and an hour before the study - smoking. On the eve of the analysis, it is desirable to avoid stress and emotional overstrain.

Enzymatic research method venous blood is the basis for the determination of lipids. The device fixes pre-painted special reagents samples. This diagnostic method allows you to conduct mass examinations and obtain accurate results.

Take tests to determine lipid spectrum With preventive purpose, starting from youth, it is necessary 1 time in 5 years. Persons over the age of 40 should do this annually. Conduct a blood test in almost every district clinic. Patients suffering from hypertension, obesity, diseases of the heart, liver and kidneys are also prescribed a lipid profile. Burdened heredity, existing risk factors, monitoring the effectiveness of treatment are indications for prescribing a lipid profile.

The results of the study may be unreliable after eating on the eve of food, smoking, stress, acute infection, during pregnancy, taking certain medications.

Diagnosis and treatment of pathology is carried out by an endocrinologist, a cardiologist, a therapist, a general practitioner, a family doctor.

Treatment

plays a huge role in the treatment of dyslipoproteinemia. Patients are advised to limit the intake of animal fats or replace them with synthetic ones, eat up to 5 times a day in small portions. The diet must be enriched with vitamins and dietary fiber. Fatty and fried foods should be abandoned, meat should be replaced sea ​​fish, eat a lot of vegetables and fruits. Restorative therapy and sufficient exercise stress improve general state sick.

figure: useful and harmful "diet" in terms of LP balance

Lipid-lowering therapy and antihyperlipoproteinemic drugs are designed to correct dyslipoproteinemia. They are aimed at lowering the level of cholesterol and LDL in the blood, as well as increasing the level of HDL.

Of the drugs for the treatment of hyperlipoproteinemia, patients are prescribed:

• - Lovastatin, Fluvastatin, Mevacor, Zocor, Lipitor. This group of drugs reduces the production of cholesterol by the liver, reduces the amount of intracellular cholesterol, destroys lipids and has an anti-inflammatory effect.
• Sequestrants reduce the synthesis of cholesterol and remove it from the body - Cholestyramine, Colestipol, Cholestipol, Cholestan.
• I lower the level of triglycerides and increase the level of HDL - "Fenofibrate", "Ciprofibrat".
• B group vitamins.

Hyperlipoproteinemia requires treatment with hypolipidemic drugs "Cholesteramine", " Nicotinic acid”,“ Miscleron ”,“ Clofibrate ”.

Treatment of the secondary form of dyslipoproteinemia is to eliminate the underlying disease. Patients with diabetes are advised to change their lifestyle, regularly take sugar-lowering drugs, as well as statins and fibrates. IN severe cases insulin therapy is required. With hypothyroidism, it is necessary to normalize the function of the thyroid gland. For this, patients undergo hormone replacement therapy.

Patients suffering from dyslipoproteinemia are recommended after the main treatment:

1. Normalize body weight
2. Dose physical activity,
3. Limit or eliminate alcohol consumption
4. Avoid stress and conflict as much as possible
5. Give up smoking.

Video: lipoproteins and cholesterol - myths and reality

Video: lipoproteins in blood tests - the program "Live healthy!"

Cholesterol is one of essential substances for any living being belonging to the animal kingdom. This fatty monohydric alcohol is one of the natural intermediate products of metabolic processes.

At the same time, it is cholesterol that is considered one of the "culprits" of atherosclerosis and some other diseases. After the discovery of the role of this substance in pathophysiological processes, cardiologists, nutritionists, and doctors of some other specialties took up arms against him. In fact, everything is not so simple and unambiguous, the trouble is not in cholesterol, as such, but in its quantity and the body's ability to absorb this substance properly.

About 80% of the need for this substance is provided by the body on its own, cholesterol is synthesized in the liver. The rest of the body receives from food of animal origin. It enters the blood in the form of complex complex compounds and is included in a number of processes, in particular:

• Growth and reproduction of cells, as one of the components of cell membranes and intracellular structures;
• Synthesis of hormones;
• Transportation of substances with antioxidant activity and fat-soluble vitamins;
• Synthesis of bile acids.

What is "bad" and "good" cholesterol

Cholesterol is insoluble in water, therefore, for transportation to target organs, it forms complex lipoprotein complexes. The complex has a spherical shape and consists of cholesterol esters and triglycerides coated with protein molecules.

There are several types of lipoprotein complexes in the blood, differing in composition and other physical and chemical properties. One of the key characteristics of the lipoprotein complex is density. On this basis, the complexes are just divided into “bad” and “good” cholesterol.

Low-density lipoprotein complexes are abbreviated as LDL and conventionally called "bad" cholesterol. High-density lipoproteins or HDL are called "good".

In fact, both LDL and HDL cholesterol are vital to keep the body functioning.

"Bad" cholesterol

As part of LDL, this compound comes from the liver to target organs, where it is included in the synthesis processes. LDL are the precursors of many hormones, including sex hormones. The body's need for readily available cholesterol is higher, so LDL accounts for over 60% of all cholesterol present in the blood. The content of cholesterol derivatives in them reaches 50%. When moving in the bloodstream, loose complexes can be damaged and cholesterol esters, which are outside the protein shell, settle on the walls of blood vessels.

With excessive intake of LDL into the blood, cells do not have time to absorb it completely, and the process of deposit formation on the walls of blood vessels accelerates. Atherosclerotic plaques form. The narrowing of the lumen of the vessels over time is manifested by vascular insufficiency, ischemia in the affected area. With the destruction of the plaque, a complete overlap of the lumen of the vessel is possible - thrombosis or thromboembolism.

"Good" cholesterol

“Good” is popularly called high-density cholesterol complexes, HDL. These compounds transport cholesterol to the liver, where it is used to synthesize bile acids and excreted from the body. The content of cholesterol in the complexes is up to 30%. In people with a normal content of this fraction of lipids in the blood, the risk of myocardial infarction is reduced to almost zero. When moving through the bloodstream, HDL captures excess cholesterol from the walls, according to some reports, even from plaques formed. If HDL cholesterol is lowered, the body cannot cope with the cleansing of the walls of blood vessels, cholesterol continues to accumulate and atherosclerosis develops.

At the same time, it should be understood that the names "bad" and "good" cholesterol are more than arbitrary. What is HDL cholesterol? In fact, it is one of the final stages of lipid metabolism, “construction debris”, which, before being disposed of, should serve the body in good stead. Replacing all the "bad" cholesterol with good is impossible and unsafe. The main thing is not so much absolute indicators content of LDL and HDL cholesterol, and their balance.

Norm of cholesterol in the blood

“Bad” and “good” cholesterol are not interchangeable compounds, they must always be present in the body, simultaneously and in a certain ratio. Deviation from the norm in the direction of increasing or decreasing the content of any of the fractions of cholesterol or any of its fractions indicates the presence serious problems in the body or a potential threat of their occurrence in the foreseeable future.

Approximate levels of cholesterol:

• General - less than 5.2 mmol / l
• Triglycerides - no more than 2 mmol / l;
• LDL - up to 3.5 mmol / l
• HDL - more than 1.0 mmol / l

The concept of a norm is rather conditional. The level of cholesterol depends on gender, age, the presence of endocrine and other chronic diseases, hereditary characteristics of lipid metabolism. This indicator is influenced by stress, physiological changes seasonal nature. The individual norm may differ slightly from the average values; in the presence of certain diseases and other risk factors, it is necessary to control cholesterol levels more strictly.

The attending physician will tell about the individual norm and permissible limits for each patient. He will make recommendations for effective reduction cholesterol levels and, if necessary, prescribe treatment.

How to normalize cholesterol

First of all, doctors recommend to adhere to special diet. Foods containing trans fats are excluded from the diet, the consumption of animal fats and sweets is limited. It is better to replace fatty meat with fatty sea fish, which contains omega-3 and omega-6 polyunsaturated fatty acids.

If necessary, the doctor will prescribe medication. The course of treatment includes:

• statins;
• Bile acid binders;
• Fibric acids;
• B vitamins, vitamin E, omega-3 fatty acids, folic acid.