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These are described according to their density. The low density and very low density lipoproteins, which are called LDL and VLDL respectively, are considered to be harmful, whereas, high density lipoproteins, which are called HDL, are useful as they remove LDL and VLDL from the blood. The fats which are carried by these lipoproteins are cholesterol and triglycerides. There are various reasons for a high level of fat in the blood. High fat levels in the blood are quite common in those who are overweight or have familial or genetic tendencies. In such persons, reducing body weight by control and regular physical exercise is sufficient to lower the blood fat level. Certain disease conditions like diabetes, decreased function of the thyroid gland, and some metabolic disorders may also be responsible for an increased blood fat levels. In these conditions control of the underlying disease is needed. How is Excessive Fat in the Blood Harmful?Raised cholesterol is a major risk factor for heart disease. An excessively high quantity of cholesterol in the blood is gets deposited on the walls of the blood vessels and make them narrow. This narrowing of the blood vessel is called atherosclerosis. The process of atherosclerosis may start at a young age but its manifestations are usually seen in older patients, by which time it has advanced considerably. Atherosclerosis may lead to a defective blood supply to various vital organs of the body. In the brain it may cause impairment of mental functions, paralysis, and unconsciousness. Another danger is the involvement of the heart. Narrowing of coronary arteries (those supplying blood to the heart muscle) may lead to a defective blood and oxygen supply to the cardiac muscle and cause disorders like angina or myocardial infarction which need treatment immediately. Preventive Measures Various measures can be undertaken to minimize the occurrence of atherosclerosis. Life style changes such as giving up or a drastic reduction smoking are needed. The patient should exercise regularly and should not overeat. Saturated fats, such as butter, ghee, animal fat, hydrogenated oils, coconut oil, oxidized oils (left over after frying), should be avoided and replaced by unsaturated or polyunsaturated fats, like vegetable oils, corn oil, groundnut oil, mustard oil, cottonseed oil, and sunflower oil. Polyunsaturated fats reduce cholesterol by removing it from tissues. The calories from fats should be 30 per cent or less and distribution of various fats should be equal (saturated fats = monounsaturated fats = polyunsaturated fats). Fish oils are rich in a type of polyunsaturated fatty acid called Omega-3 fatty acid. There are reports of reduction of triglycerides and antiatherogenic effects of fish oils. Fresh fruits and green vegetables have high levels of antioxidants which are useful. The dictum to be followed should be 'Never a day without fruit.' Sugar intake should be reduced. Total caloric intake should be lowered so that there is a gradual decrease in weight. It has been observed that the these measures help in reducing plasma fat in most cases. However, when these measures are ineffective, drugs may be employed. It must be remembered that once a heart attack has occurred, the reduction of plasma lipids will decrease the chances of future attacks. Blood Cholesterol: How Much Reduction is Beneficial? Conventional normal value may be too high for Indian cases because various studies have shown that we are genetically more prone to heart disease (and are likely to have more complications at young age!) and tolerate cholesterol levels poorly. Hence, lower values are recommended. Obviously aggressive reduction of blood cholesterol reduces chances of atherosclerosis. Ezetimide (Ezetip, Lipezet 10 mg tab) This drug prevents absorption of cholesterol from small bowel. It reduces LDL-cholesterol levels and further reduces LDL-C by 25% and triglycerides by 14%. It is well tolerated but occasional abdominal pain, diarrhoea, joint pains, headache, dizziness may be there. Its usual dose is 10 mg once a day regardless of meals. It can be combined with statins. Nicotinic acid (Nialip 500 mg tab) It is Vitamin B3 (Niacin or nicotinamide) derivative and reduces tryglycerides and VLDL-C (20­50%) rapidly and followed by LDL-C (15-25%) subsequently. It is the most effective drug to raise good cholesterol (HDL-C) by 15-30%. It acts on liver and prevents formation of triglycerides. Starting dose is 100 mg thrice a day with meals and gradually increased to 2 g to 6 g per day. Adverse Effects: It is a poorly tolerated drug. It causes dyspepsia, flushing, itching and sensation of heat (skin blood vessels widen). It also causes diarrhoea, darkening of skin, worsening of diabetes, joint pains in gout and irregular heart beats. It is never given in pregnancy. 'It increases fall in BP due to drugs used for the treatment of high blood pressure. Other Drugs Guggulipid (GUGLIP 25 mg tab) is a plant derivative (gum guggul) which lowers lipids modestly. It may cause loose motions.