Dyslipidemia - A Homoeopathic Insight

INTRODUCTION: Atherosclerotic vascular disease - the epidemic of this century, is a metabolic disease gaining a strong foothold in the human community at large, especially the younger generation. Moreover numerous epidemiological studies have proved beyond doubts that Asian Indians have the highest rates of atherosclerotic coronary artery disease (CAD) of any ethnic group, despite the fact that nearly half of this group are life-long vegetarians. It occurs early in age and generally follows a malignant course.
In this era of Mixed Miasms, atherosclerotic disorders stand out to the fore. Its a process that begins in early childhood continues throughout life and becomes clinically apparent only in early middle age or later as seen in Indians. Although the incidence of classic risk factors are Hypercholesterolemia, high triglyceride and low high-density lipoprotein cholesterol levels, high lipoprotein (a) levels, and apple-type obesity all show a substantial prevalence in our population. At the Shaad Heart Care Centre - the research wing of The National Academy of Homoeopathy India, we measured Serum Total cholesterol levels in 147 young healthy men aged 16 -26 years between March to October, 2001. The values were predictive of the risk of coronary artery disease in 67% of the sample studied.
PLASMA LIPIDS:
The following are Serum lipids, the variation in values of which constitute dyslipidemia
Serum Total Cholesterol
Serum Triglycerides
Serum Low Density Lipoprotein Cholesterol (LDL-C)
Serum Very Low Density Lipoprotein Cholesterol (VLDL-C)
Serum High Density Lipoprotein Cholesterol (HDL - C)
Serum Apolipoprotein B
Serum Apolipoprotein A1
Serum Lipoprotein (a)
The cholesterol levels in the first few months of life increase tremendously due to changes in LDL. Over the next 17-20 years the values stabilize in both sexes between 150 -170 mg/dl. Thus children with high cholesterol levels tend to have higher levels as young adults too and vice-versa. The HDL cholesterol levels remain stable in females but decline significantly in the 2nd decade in Males. Plasma triglycerides stabilize to a mean of 75 mg/dl by 20 years of age. A strong association exists between the presence of coronary artery disease and elevated Lipoprotein (a) concentration (30mg/dL and<). Most series of young coronary patients have shown that obesity is more common than in controls.
Despite the association of obesity with ischemic heart disease there is still considerable debate on whether it constitutes an independent risk factor. Although some children suffer from well-defined familial hyperlipidemia, the majority do not have such syndromes. Also, those with hyperlipidaemia are at increased risk for heart disease yet not all such individuals acquire clinical heart disease. Why?
HOMOEOPATHIC VIEW POINT:
Well! the answer to the above question lies not in hyperlipdaemia alone but the Tendency of Atherogensis due to hyperlipidaemia. This is a Psoro-sycotic phenomenon. The end result or the Disease Ultimate is a Thrombus or an Atheroma (single or multiple). This Atheroma is composed of fatty streaks of Blood lipids, platelets and calcium. All of which find a nidus on the injured intima of the arteries and arterioles. Acute coronary syndromes like Angina pectoris (stable or unstable), myocardial infarction or congestive cardiac failure are the secondary effects of this tertiary sycotic miasm - a useless deposition of lipid-platelet-calcium complex in the coronaries. Likewise, such depositions can occur in any blood vessel of any major organs, thereby exhibiting the respective clinical syndromes as Stroke, Pulmonary thromboemolism & infarction, peripheral arterial disease, arteriolar nephrosclerosis, etc. As the miasmatic schedule shifts deeper from the functional to organic plane, even the veins which are ordinarily free of atheroma develop the lesions when pressure within them is increased.
CLINICAL FEATURES - Depending upon the arterial affection of a particular organ system, the clinical features differ. Majority are asymptomatic till late. Many show early tendency to obesity like children of Antim crudum, or calc carb etc.
When the coronaries are stenosed then we have a spectrum of clinical entities ranging from easy fatiguability, angina pectoris (stable, unstable, prinzmetal), myocardial infarction and its attendent consequences or complications
When the carotid or vertibro-basilar system has clinically significant atheromatous plaques then again we have a different array of stroke syndromes - Transient ischemic attacks, Vertebrobasilar artery insufficiency, Reversible ischemic neurological deficit, Completed Stroke.
When the peripheral circulatory tree is affected then we have clinical entities as Burgers disease leading to Gangrene of the affected part.
MANAGEMENT:
Dietary Management - First approach and mainstay of dyslipidaemia remains dietary modification. The physician should seek to achieve the ideal body weight maintaining normal growth velocities in all cases. Dietary modification is safe in the treatment of hyperlipidemia in adults and children older than 2 years of age but the younger children should be excluded from such modifications because of importance of dietary fat in neural growth and development. In patients with elevated total or LDL cholesterol (Cholesterol = 200 mg/dl and LDL Cholesterol = 130 mg/dl), diet should be designed to reduce total fat intake to less than 30% of total calories (10% each of saturates, mono unsaturates, & poly unsaturates) and to reduce the cholesterol intake to less than 100 mg / 1000 calories/day. The minimum goal is to achieve LDL Cholesterol to less than 110 mg/dl.
Acute Management - Although a constitutional approach is the sublime and true homoeopathic approach, yet at times certain cases require aggressive lowering of plasma lipid levels. The management of clinical emergencies as myocardial infarction or gangrene due to the atherogenesis or dyslipidemia constitutes a seperate entity and requires comprehensive managerial skills, tools and remedies, but the discussion is beyond the scope of this topic. At our set-up, we have extensively used the following drugs with miraculous and reliable results.
a) Vipera
b) Terminalia Arjuna
c) Ferrula Sumbul
3. Constitutional Antimiasmatic management - This ultimately forms the key feature of homoeopathic management of any metabolic disorder -especially atherosclerois and /or dyslipidemia