Cholesterol Ratio

Cholesterol is the fatty substance found in the body and they come in different forms based on density. Cholesterol facilitates some of the vital functions in the body such as hormone formation, cell structure and also digestion. However, the estimation of cholesterol ratio in an individual determines a person’s risk of heart disease. Cholesterol ratio is often measured by taking the good cholesterol – high density lipoprotein ratio and bad cholesterol low density lipoprotein ratio. In order to calculate the total cholesterol level, the value of good cholesterol is divided by the total cholesterol. For treatment purposes, it is important that the values pertaining to good cholesterol(HDL) and bad cholesterol (LDL) are measured.

Our body transports fats(lipids) and water based blood within a single circulatory system. It uses a combination of fats with protein to form water soluble packages called as lipoproteins so that essential fatty nutrients can be transported in the blood and also that fatty waste products can be carried away from body tissues. Lipoproteins are a complex mixture of triglycerides, cholesterol, phospholipids and special proteins. There are five different sizes of these chemical packages with each holding four distinct chemicals in it. Ultracentrifuge will split blood serum into different layers based on density in a test. They are:

• High Density Lipoproteins (HDL): HDL are made in the intestines and the liver. HDLs consist of about 50% protein and 19% cholesterol. They help to remove cholesterol from artery walls. This is why HDLs are addressed as good cholesterol.
  
  
• Low Density Lipoproteins (LDL)
  LDL carry cholesterol from the liver to other parts of body.They contain about 50% cholesterol. Extra LDLs are absorbed by the liver and excreted into the bile. LDL particles are involved in the formation of plaques in the walls of the coronary arteries. This is why LDL is addressed as bad cholesterol.
  
  
• Intermediate Density Lipoproteins (IDL): IDLs are temporary lipoproteins containing about 30% cholesterol that are converted in the liver to low density lipoproteins (LDLs).
  
  
• Very Low Density Lipoproteins (VLDL): These lipoproteins carry mostly Triglycerides, but they also contain 16–22% cholesterol. VLDLs are made in the liver and eventually become IDL particles after they have lost their Triglyceride content.
  
  
• Chylomicrons Found in the blood after eating fatty food. They contain about 7% cholesterol. Chylomicrons transport fats and cholesterol from the intestine into the liver, then finally into the bloodstream. They are metabolized in the process of carrying food energy to muscle and fat cells.
  

Good cholesterol / High density lipoproteins

High density lipoproteins play a very significant role in the cleaning up excess cholesterol present in the blood vessels to prevent plaque formation thus acting as effective scavengers. The excess cholesterol is transported to the liver for breakdown and excretion. The levels of HDL in the blood determine the intensity of cleaning process of the blood vessels to prevent atherosclerosis leading to coronary artery disease. The level of cholesterol is measured by milligrams per deciliter of the blood. The normal range for HDL in men and women is 60mg/dl or above. Any value below these levels indicates that the individual is susceptible heart disease. Hence the concentration of HDL is inversely related to cardiovascular disease. HDL also pays an important role in lipoprotein metabolism in donating proteins such as Apo c2, Apo E and VLDL.

Increasing good cholesterol in the body

HDL concentrations increase in the body depends on the lifestyle of an individual. Avoiding smoking can effectively raise the levels of HDL in the body. This accounts for 10 percent rise in the HDL level. Obesity is a major cause for cardiovascular disease and many other associated diseases. Losing excess weight in the body can yield in a gradual increase of HDL levels. Exercises pertaining to cardiac activity such as running, brisk walking, swimming, aerobics can enhance the levels of HDL significantly. Alcohol consumption should be limited to moderate. Choosing the right kind of fats in the diet enables increase in good cholesterol levels. Avoiding foods containing saturated and trans fats is advisable. These fats tend to increase the low density lipoproteins which damage the blood vessels. Fats which contain polyunsaturated and mono unsaturated fatty acids are safe and they increase the level of HDL in the body. Foods containing these fatty acids include olives, peanuts, canola, fish etc. These fatty acids improve the anti-inflammatory action of the HDL.

In addition to changes in lifestyle, medications can also help improve the level of HDL in the body subsequently lowering the LDL levels. Therapeutics such as niacin in association with statins and cholestyramine increase the level of HDL. Statins block substances in the liver which makes cholesterol. They also reabsorb excess cholesterol in the artery walls. These drugs are often used in people who have a history of cardiovascular disease. In addition, fibrates such as fenofibrate and gemfibrozil enhance the HDL level.

Cirrhosis

The liver is responsible for neutralizing the blood of toxins, germs and bacteria as well as producing immune agent to control infections. Bile, critical to the absorption of fats and fat-soluble vitamins is made by the liver. Cirrhosis is a condition where the liver is affected by irreversible scar tissue leading to its damage and consequent failure. Blood flow to the liver is then affected. Symptoms of cirrhosis range from exhaustion and fatigue to weight loss and abdominal pain. A person suffering from liver cirrhosis may experience abdominal pain and loss of appetite. There are noticeable red spider veins under the skin and the skin and eyes may turn yellow. There is decreased interest in sex and edema (swelling on hands and legs) might be noticed. A person suffering from cirrhosis and damaged liver may notice an increased tendency to bruise and bleed easily. Intense itching is felt on account of the bile products being deposited in the skin. Gallstones may develop as a result of inadequate bile reaching the gallbladder. There might be a buildup of toxins in the brain bringing about bouts of unresponsiveness and forgetfulness. Cirrhosis can bring on Portal hypertension - a condition where there is reduced flow of blood to the portal vein and increased pressure within it. Cirrhosis can eventually lead to liver cancer caused by carcinoma. Impotence, kidney dysfunction and osteoporosis are other likely complications of liver disease.

Cirrhosis of the liver is usually caused by chronic alcoholism or hepatitis C. Other possible factors leading to cirrhosis are problems in the immune system and damaged bile ducts.
Chronic Alcoholism - One of the common causes for cirrhosis is alcoholism. But this condition occurs only after at least 10 years or more of heavy drinking. Alcohol affects the liver's ability to metabolize proteins, fats and carbohydrates.
Chronic hepatitis - Hepatitis C virus can lead to severe inflammation and damage of the liver, thereby causing cirrhosis. Hepatitis B is one of the most common causes of liver inflammation in many of the developing nations.
Blocked bile ducts - In such a condition, the bile is unable to travel out of the liver and instead ends up damaging liver tissue. This can be a congenital defect in some infants.

Cirrhosis of the liver can cause many other abnormalities. It can leads to elevated levels of triglycerides, cholesterol and sugar. Diabetes mellitus is a common fallout. There might be a fall in platelet count and GI bleeding. In severe cases of cirrhosis, there can be an immune system dysfunction or even brain swelling and later coma. The liver of an affected person will feel be larger and harder to touch. A liver scan or ultrasound can help detection of cirrhosis. A liver biopsy is sometimes resorted to. Damage to the liver due to cirrhosis cannot be reversed but further complications can be reduced with the right treatment. Cirrhosis caused by excess alcohol consumption needs lifestyle changes such as avoiding alcohol and following a nutritious diet. Low-sodium diet can help drain excess fluid-buildup within the body. Chronic viral hepatitis B and C are treated with prednisone and azathioprine. Any bacterial infection is treated with appropriate antibiotics. Liver transplantation surgery is done on cases where the liver is not capable of functioning. With the help of modern drugs such as cyclosporine and tacrolimus, the success of liver transplantation surgery has risen manyfold.

Niemann pick

Niemann pick is a type of lysosomal storage disease and is an inherited condition that involves the metabolism of lipids. This leads to a breakdown in the of use and transport of fats and cholesterol in the body. The disease affects the body's ability to mobilize fat within cells. When this fat (cholesterol and lipids) accumulates in large amounts, it causes dysfunction of the cell and untimely death of a person. Harmful levels of lipids accumulate in the spleen, lungs, liver, bone marrow and brain. Niemann pick disease is more common in children. The disease is classified into three major types namely Niemann pick A, B and C. Niemann pick Type A and Type B are caused by the deficiency in an enzyme called acid sphingomyelinase. This enzyme is found within the lysosome cells and is an essential component in metabolizing a lipid called sphingomyelin.

Symptoms are related to the type of disease.

Type A: occurs in children. Children may not survive as the condition affects the nervous system. Symptoms include:

• Enlarged spleen and liver
  
• Progressive deterioration of the nervous system
  
• Stunted growth
  
• No weight gain.

Type B: occurs in childhood, known as the non-neurological type as the nervous system is not affected. Children survive into adulthood.

• Growth retardation
  
• Splenomegaly
  
• High cholesterol and lipid levels in the blood
  
• Low platelet levels
  
• Lung infection
  
• Problems in the functioning of the lungs.

Type C: can occur in children or in adults

• Severe liver disease
  
• Breathing difficulties
  
• Seizures
  
• Poor muscle tone
  
• Developmental delay
  
• Eye problem
  
• Problems in feeding
  
• Lack of coordination.

Other general symptoms include:

• Seizures
  
• Cataplexy (sudden loss of muscle tone)
  
• Dystonia (excessive muscle contraction)
  
• Accumulation of sphingomyelin in the central nervous system shows symptoms and signs like slurred speech (dysarthria) and abnormal swallowing (dysphagia)
  
• Recurrent pneumonia
  
• Difficulty in swallowing and eating
  
• Sleep disturbances
  
• Sleep inversion (sleepiness during the day and wakefulness during the night)
  
• Bones are affected.

Diagnosis depends on the type of Niemann pick disease

For Type A or B: Blood sample or bone marrow sample is used to measure the level of acid sphingomyelinase in the blood.
For Type C: A small sample is skin is taken to test how the cells move and store cholesterol.

Other tests may include brain MRI, genetic testing and eye test to confirm if there is difficulty in normal eye movement