Dyslipidemia



Editors

Leonor Corsino, MD, MHS, FACE  

Gordon H. Williams, MD

William F. Young, Jr., MD



Additional Resources
MedlinePlus (NIH)
American Heart Association

What is dyslipidemia?

Dyslipidemia is an abnormal level of cholesterol and other lipids, also called fats, in the blood. Lipids (fats) are important for life. They are important component of the living cells. However, high levels can increase your risk of getting a heart attack or heart disease. 

Below are the desirable levels of blood cholesterol for most adults over the age of 20. However, the cholesterol goals might be different depending on your risk for a stroke or heart attack.

The most common goals are:  

  • Total cholesterol: Below 200 mg/dL
  • HDL cholesterol: Men - above 40 mg/dL; Women - above 50 mg/dL
  • LDL cholesterol: Below 100 mg/dL; Below 70 mg/dL for people with diabetes or heart disease.
  • Triglycerides: Below 150 mg/dL

The most common types of high cholesterol (dyslipidemia) 

  • High levels of low-density lipoprotein (LDL or “bad”) cholesterol
  • Low levels of high-density lipoprotein (HDL or “good”) cholesterol
  • High levels of triglycerides

When LDL cholesterol levels are high, fatty deposits (called plaques) can build up in the arteries, the blood vessels that carry blood from the heart throughout the body. Over time, plaques narrow the arteries, producing atherosclerosis (hardening of the arteries). This can cause heart disease, heart attack, peripheral artery disease (reduced blood flow in the limbs, usually the legs), or stroke.

Low levels of HDL and high levels of triglycerides can also increase fat build-up in the arteries. High levels of HDL cholesterol, however, protect the heart by helping to remove the build-up of LDL from the arteries.

What are the causes of high cholesterol? 

There are many reasons why people might have high cholesterol. Some of the most common causes are being overweight or obese, diabetes, hypothyroidism (low levels of thyroid hormone), Polycystic Ovary Syndrome (PCOS), metabolic syndrome, Cushing syndrome, genetic or family, and some medications. 

What can I do to get my cholesterol under control or treat my high cholesterol? 

Patients with high cholesterol can treat it in several ways. Some of the most important ways you can control your cholesterol include the following: 

  • Lifestyle changes: High cholesterol can often get better with lifestyle changes. However, it is always important to discuss with your doctor if medications are also needed.

The following lifestyle changes are proven to work for people with high cholesterol: 

  1. Exercise: regular exercise such as walking, biking, running, or other forms of exercise will help you keep your cholesterol under the recommended levels. 
  2. Nutrition and food: eating a balanced diet is very important. Discuss with your health care provider what diet is the best for you. 
  3. Losing weight if you're overweight or obese. Even small amount of weight loss will help. Losing between 5-10% of your weight can make a big difference. 
  4. Stop smoking: if you are a smoker, quitting is one of the most important things you can do to get your cholesterol under control and to avoid heart disease. If you need help quitting, please discuss what options do you have with your health care provider. 
  • Medication: There are several medications that can help you get your cholesterol under control. Before you start taking any medications please make sure you discuss them with your health care provider. Your health care provider will guide you and provide the information you need to make the decision regarding what is the best medication for you. 

 

How do hormone disorders cause dyslipidemia?

The most common lipid disorder is hyperlipidemia, high levels of blood fat. While many of its possible causes are not related to the endocrine system, hyperlipidemia can also be related to a hormonal disease such as diabetes, hypothyroidism (low levels of thyroid hormone), polycystic ovary syndrome (PCOS), metabolic syndrome, and Cushing syndrome. Central obesity (excess fat around the waist) or insulin resistance (a condition in which the body doesn’t use insulin properly), or both—each of which are risk factors for dyslipidemia—are often found in people with these endocrine disorders.

Diabetes

Diabetes is a disease in which blood glucose (sugar) levels are higher than normal. Over time, too much glucose in the blood can lead to increased plaque deposits on the insides of the blood vessel walls.

Because people with diabetes are at high risk for cardiovascular disease, keeping blood sugar levels close to normal is important to prevent this and other serious complications. Regulating blood pressure and lipid levels is especially important to manage cardiovascular disease risk. The most typical lipid pattern in diabetes consists of high triglyceride levels, low HDL levels, and small, dense LDL particles, which easily stick to artery walls. This lipid pattern is linked with central obesity and insulin resistance.

Hypothyroidism

Thyroid hormone regulates metabolism—how the body uses and stores energy—and affects nearly every organ in body. It also plays a role in regulating lipids. Hypothyroidism (low thyroid hormone production) can cause many of the body’s functions to slow down.

Early diagnosis of hypothyroidism is important because people with untreated hypothyroidism have abnormal lipid levels that can lead to cardiovascular disease. These patients have high blood levels of LDL, and some have high levels of triglycerides. Hypothyroidism is treated with thyroid hormone medication. Treatment usually leads to a big improvement in dyslipidemia.

Polycystic ovary syndrome

PCOS consists of a group of symptoms and changes in hormone levels. Women with this condition often have many small painless cysts in the ovaries. Symptoms include irregular or absent menstrual periods, infertility, weight problems, acne, excess facial and body hair, and thinning head hair. Most women with PCOS have insulin resistance and many are overweight.

Dyslipidemia is common in women with PCOS. They often have increased levels of LDL cholesterol. Overweight women with PCOS may also have low levels of HDL cholesterol and high levels of triglycerides. These lipid disorders put women with PCOS at increased risk for cardiovascular disease later in life. PCOS is not curable, but it can be managed with medications and changes in diet and exercise.

Metabolic syndrome

The term metabolic syndrome refers to a group of metabolic risk factors, described below. People who have the metabolic syndrome are at risk to develop serious conditions like cardiovascular disease and diabetes. The exact cause of the metabolic syndrome is unknown, but genetic factors, too much body fat (especially around the waist), and lack of exercise contribute to it.

Metabolic syndrome is often defined as the presence of three or more risk factors.

  • Elevated waist circumference: Men - equal to or greater than 40 inches; Women - equal to or greater than 35 inches
  • Reduced HDL cholesterol: Men - less than 40 mg/dL, or currently taking medication to increase HDL; Women - less than 50 mg/dL, or currently taking medication to increase HDL
  • Elevated triglycerides: Equal to or greater than 150 mg/dL, or currently taking medication to lower triglycerides
  • Elevated blood pressure: Equal to or greater than 135/85 mm Hg, or currently taking medication to reduce BP
  • High blood glucose: Fasting glucose equal to or greater than 100 mg/dL, or currently taking medication to lower glucose levels

The main goal of treatment is to lower the risk of cardiovascular disease and diabetes. This includes quitting smoking and reducing LDL (bad) cholesterol, blood pressure, and glucose to recommended levels. Lifestyle changes also help: losing weight, eating a healthy diet with fewer fats and cholesterol, and increasing physical activity (at least 30 minutes of moderate intensity exercise most days of the week).

Cushing syndrome

Many people with endogenous Cushing syndrome (not caused by medication) have hyperlipidemia due to long-term exposure to high levels of cortisol. One reason for this lipid disorder is that cortisol affects where fat is stored, and when cortisol levels remain high, fat accumulates around the waist.

 

Edited: May 2018