We shall open our overview of issues related to
obesity and
hyperlipoproteinemia (HLP) or
dyslipidemia with a notoriously known truth (that some are still reluctant to accept): HLP/DLP is not
obesity. It is certainly not possible to put an equal sign between subcutaneous fat and the level of plasma
lipids and
lipoproteins. On the other hand, it is obvious that there is a number of connecting links between HLP/DLP and
obesity. These associations on one side and differences on the other are the focus of this review paper. (1) HLP/DLP as well as
obesity represent a group of high incidence
metabolic diseases (gradually evolving from epidemic to pandemic) that affect several
tens of percent of inhabitants. (2) Both HLP/DLP and
obesity often occur concurrently, often as a result of unhealthy lifestyle. However, genetic factors are also been studies and it is possible that mutual predispositions for the development of both diseases will be identified. At present, it is only possible to conclude that
obesity worsens lipid metabolism in genetically-determined HLP. (3) Both these
metabolic diseases represent a risk factor for other pathologies,
cardiovascular diseases are the most important common complication of both conditions (central type of
obesity only). Concurrent presence of HDL/DLP and
obesity is often linked to other diagnoses, such as
type 2 diabetes mellitus (DM2T),
hypertension, pro-coagulation or pro-inflammatory states; all as part of so called
metabolic syndrome. (4) Patients with
metabolic syndrome and, mainly,
central obesity usually have typical
dyslipidemia with reduced
HDL-cholesterol (HDL-C) and sometimes hypertriglyceridaemia. Current treatment of HDL/DLP aims to first impact on the primary aim, i.e.
LDL-cholesterol (
LDL-C), and than influence HDL-C. (5) It seems that the therapeutic efforts in HLP/DLP and
obesity will go in the same direction. I will skip the trivial (and difficult to accept by patients) dietary changes.
Pharmacotherapy, however, (very scarce with respect to
obesity) may bring positive effects on
lipids and BMI.
Metformin used to be considered as a drug that could improve
lipid profile and lead to
body weight reduction. Even though larger studies did not provide an unambiguous evidence for this,
metformin keeps its position as a first line oral
antidiabetic (not only) in patients with T2DM, HLP and
obesity. Positive effect on
lipids, mainly HDL-C is reported with
pioglitazone. This drug, unlike other
glitazones, does not bring
body weight reduction but at least does not have a negative effect. Other
antidiabetics with a positive effect on
lipids and
body weight include
incretins, liraglutid in particular. Liraglutid importantly decreases
triglyceride levels and has
anorectic effect. Furthermore, metabolic effects of
bariatric surgery should not be overlooked.
Bariatric surgery brings
weight reduction as well as it improves
lipid profile and compensation of
diabetes mellitus (DM). It should be mentioned here that
bariatric surgery has been used for the treatment of HLP as early as 1980s. The results of the 25-year follow up within the POSCH study (ideal bypass indicated for HLP), presented in 2010, confirm a decrease in overall as well as cardiovascular mortality in an operated group, even though patients who did not undergo surgery were significantly more frequently treated with
statins.