Hyperlipidemia

Condition

What is hyperlipidemia?

Hyperlipidemia means there are high levels of fats (or lipids) in the blood. These fats include cholesterol and triglycerides, which are important for our bodies to function. When levels are too high, these lipids can put people at risk for heart disease, stroke, or pancreatitis (inflammation of the pancreas).

What causes hyperlipidemia?

Hyperlipidemia can be caused by both genetic and environmental factors.  Individuals who are genetically predisposed to hyperlipidemia have trouble processing lipids normally.  This can be worsened when your diet contains too much cholesterol, saturated fat, or carbohydrates. 

Lipids do not dissolve in water. For them to be carried in the blood (which is mostly water), they have to combine with a protein produced by the liver to create a lipoprotein. There are several kinds of lipoproteins in the body:

  • Low-density lipoprotein (LDL, "bad cholesterol")
  • High-density lipoprotein (HDL, "good cholesterol")
  • Very low-density lipoprotein (VLDL, mostly made up of triglycerides from the liver)
  • There are several other cholesterol-carrying proteins in the blood which are not usually measured.

LDL is cholesterol-rich and can build up in the arteries (the blood vessels that carry blood throughout the body).  Accumulation of cholesterol can cause plaque to form in the arterial walls, resulting in heart and vascular disease.  If these plaques rupture, they can cause a heart attack.  On the other hand, HDL removes the build-up of LDL cholesterol from the arteries and carries it back to the liver.  In this way, HDL is thought to be protective against heart disease.  High levels of VLDL and triglycerides are common in individuals who have obesity or diabetes.  In these cases, HDL levels are often low, and the risk for heart disease is high.

What are the risk factors for hyperlipidemia?

Being overweight or obese, not getting enough exercise, and eating a diet high in saturated fat, carbohydrates, cholesterol and low in fruits, vegetables and fiber can contribute to hyperlipidemia. Beyond diet, however, there are other factors that can lead to this condition.

LDL is cholesterol-rich and can build up in the arteries (the blood vessels that carry blood throughout the body).  Accumulation of cholesterol can cause plaque to form in the arterial walls, resulting in heart and vascular disease.  If these plaques rupture, they can cause a heart attack. On the other hand, HDL removes the build-up of LDL cholesterol from the arteries and carries it back to the liver. In this way, HDL is thought to be protective against heart disease.  High levels of VLDL and triglycerides are common in individuals who have obesity or diabetes.  In these cases, HDL levels are often low, and the risk for heart disease is high.

What are the risk factors for hyperlipidemia?  

Risk factors for hyperlipidemia include: overweight or obese, lack of physical activity, diets high in saturated fats and simple carbohydrates, and low in fruits, vegetables and fiber. Family history of hyperlipidemia can also predispose you to hyperlipidemia.

Hyperlipidemia can run in families as a genetic disorder:
  • Familial hypercholesterolemia –LDL cholesterol levels are high
  • Familial hypertriglyceridemia –Triglyceride levels are high
  • Familial combined hyperlipidemia –Levels of LDL cholesterol, triglycerides, or both are high, and HDL is low
  • Familial dysbetalipoproteinemia – rare genetic disorder in which both triglycerides and cholesterol are equally elevated  
  • Familial chylomicronemia syndrome (FCS) – rare genetic disorder resulting in high triglycerides

Hyperlipidemia can also be related to a hormonal disease such as diabetes, hypothyroidism (too little thyroid hormone), kidney disease, liver disease, and Cushing’s syndrome (too much cortisol, sometimes called “the stress hormone.” Certain medications could worsen hyperlipidemia:

  • Estrogens 
  • Thiazide diuretics (water pills)
  • Beta-blockers
  • Steroids 

How is hyperlipidemia diagnosed?

Hyperlipidemia is diagnosed with a simple blood test to measure levels of cholesterol and triglycerides. There is some controversy regarding when adults should be screened for hyperlipidemia.  If they have not been screened during childhood, it is reasonable to check a lipid panel in young adults.  Intervals at which to retest are then based on the individual’s cardiovascular risk assessment.  Risk factors for cardiovascular disease include high blood pressure, smoking, family history of heart disease at a young age, diabetes, obesity, kidney disease, inflammatory diseases, and premature menopause, among others.

DESIRABLE LEVELS OF BLOOD FATS
Total cholesterol Less than 200 mg/dL
HDL cholesterol Greater than 40 mg/dL for men and 50 mg/dL for women
LDL cholesterol
  • Less than 130 mg/dL for most people
  • Less than 100 mg/dL for people with heart disease or diabetes, less than 70 mg/dL , if they had a heart attack or stroke
Triglycerides Less than 150 mg/dL

How is hyperlipidemia treated?

Improving your diet, losing weight, and getting enough exercise are important for preventing and managing hyperlipidemia.  However, if you have a genetic predisposition to certain hyperlipidemias, additional medications are likely needed to lower the risk of cardiovascular disease.

Statins are the most common medication prescribed for lowering LDL cholesterol and can reduce the risk of both heart attacks and strokes. Ezetemibe may be added to statin therapy if LDL levels remain above goal.  Newer medications called PCSK9-inhibitors are very effective at lowering LDL and reducing heart disease.  However, they are expensive and often reserved for cases of severe hyperlipidemia when goals are not met with a statin and ezetimibe, alone.  Fibrates, omega-3 fatty acids, and niacin are used to lower triglycerides and to raise HDL cholesterol.  

Questions to ask your doctor

  • How often should I have my blood fat levels checked?
  • What is the cause of my high lipid levels
  • What kind of changes do I need to make to my diet and exercise habits? 
  • Do I need to take medication? What kind? 
  • Should I see an endocrinologist or cardiologist? 
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