Dyslipidemias and Obesity

The studies that initially suggested the association between obesity, dyslipidemia and coronary heart disease were population-based studies, in which the predictive factors for coronary heart disease were investigated. In a later study of this same Framingham group, it was suggested that obesity was an independent risk marker for coronary artery disease. Other reports showed that also in obese individuals the elevation of the fraction of low-density lipoprotein-LDL and the reduction of the fraction of high-density lipoproteinHDL had a positive correlation with the risk of coronary heart disease. It was also observed that triglyceridemia would have a positive correlation with the risk of coronary heart disease. Hypertriglyceridemia in the obese results from greater synthesis and less removal of triglyceride-rich lipoproteins. In the obese individual, the greater supply of free fatty acids supplied to the liver promotes the greater production of very low-density lipoprotein particles-VLDL cholesterol rich in triglycerides. The hyperinsulinemia observed in metabolic syndrome contributes to the increased formation of these particles in the hepatocyte. For the treatment of dyslipidemia associated with obesity, the patient should receive guidance to lose weight, through an adequate diet and physical exercises. Regarding the diet, there is a controversy about which carbohydrate content it should contain, since, once the fat content is decreased, an increase in the carbohydrate content may occur, favoring hyperinsulinism and postprandial hyperglycemia. In individuals undergoing a strict weight losing diet, a transient phase of increased triglyceride and total cholesterol levels and decreased HDL-cholesterol levels may occur. In some cases, it is necessary to use lipid-lowering medications, the choice of which will depend on the type of lipid alteration found and the patient's response to treatment