Article updated and reviewed by Hubert Chen, MD, Associate Director of Medical Sciences, Amgen Inc. and Assistant Professor of Clinical Medicine University of California, San Francisco on May 17, 2005.
Hyperlipidemia is an excess of fatty substances called lipids, largely cholesterol and triglycerides, in the blood. It is also called hyperlipoproteinemia because these fatty substances travel in the blood attached to proteins. This is the only way that these fatty substances can remain dissolved while in circulation.
Hyperlipidemia, in general, can be divided into two subcategories:
- hypercholesterolemia, in which there is a high level of cholesterol
- hypertriglyceridemia, in which there is a high level of triglycerides, the most common form of fat
The fat-protein complexes in the blood are called lipoproteins. The best-known lipoproteins are LDL (low density lipoprotein) and hdl (high density lipoprotein).
Excess LDL cholesterol contributes to the blockage of arteries, which eventually leads to heart attack. Population studies have clearly shown that the higher the level of LDL cholesterol, the greater the risk of heart disease. This is true in men and women, in different racial and ethnic groups, and in all adult age groups. Hence, LDL cholesterol has been labeled the “bad” cholesterol.
In contrast, the lower the level of HDL cholesterol, the greater the risk of coronary heart disease. As a result, HDL cholesterol is commonly referred to as the “good” cholesterol.
Low HDL cholesterol levels are typically accompanied by an increase in blood triglyceride levels. Studies have shown that high triglyceride levels are associated with an increased risk of coronary heart disease.
Common secondary causes of hypercholesterolemia (specifically, high LDL cholesterol) include hypothyroidism (that is, low thyroid hormone levels), pregnancy, and kidney failure.
Common secondary causes of hypertriglyceridemia include diabetes, excess alcohol intake, obesity, and certain prescription medications (such as glucocorticoids and estrogen).
Hyperlipidemia, along with diabetes, hypertension (high blood pressure), positive family history, and smoking are all major risk factors for coronary heart disease.
Hyperlipidemia usually has no noticeable symptoms and tends to be discovered during routine examination or evaluation for atherosclerotic cardiovascular disease. However, deposits of cholesterol (known as xanthomas) may form under the skin (especially around the eyes or along the Achilles tendon) in individuals with familial forms of the disorder or in those with very high levels of cholesterol in the blood. Individuals with hypertriglyceridemia may develop numerous pimple-like lesions across their body. Extremely high levels of triglycerides may also result in pancreatitis, a severe inflammation of the pancreas that may be life-threatening.
Diagnosis is typically based on medical history, physical examination, and blood tests (done after overnight fasting) in order to determine the specific levels of LDL cholesterol, HDL cholesterol, and triglycerides.
It is necessary to first identify and treat any potential underlying medical problems, such as diabetes or hypothyroidism, that may contribute to hyperlipidemia. Treatment of hyperlipidemia itself includes dietary changes, weight reduction and exercise. If lifestyle modifications cannot bring about optimal lipid levels, then medications may be necessary.
Current national guidelines suggest a LDL cholesterol goal of <100 mg/dl for individuals already with heart disease or diabetes, <130 mg/dl for those with moderate risk of heart disease, and <160 mg/dl for everyone else. Your doctor can calculate your “risk score” for heart disease. This score can then be used to determine whether you need to start taking medications to lower your LDL cholesterol.
Although there are no firm treatment targets for HDL cholesterol or triglycerides, most experts agree that optimal HDL cholesterol and triglyceride levels are >40 mg/dl and <200 mg/dl, respectively.
Medications most commonly used to treat high LDL cholesterol levels are statins, such as atorvastatin (Lipitor) or simvastatin (Mevacor). These medications work by reducing the production of cholesterol within the body. Although safe and effective, statins very rarely cause muscle damage, typically when used in combination with other medications. Thus, it is important to let your doctor know whether you develop any generalized body ache or start a new medication when you are taking statins.
Other medications used to treat high LDL cholesterol levels include ezetimibe (Zetia), which decreases the absorption of cholesterol from the gut; bile-acid sequestrants (Questran), which eliminate cholesterol from the body; and nicotinic acid (niacin), which, in addition to lowering LDL cholesterol, raises HDL cholesterol.
Hypertriglyceridemia is typically treated with a class of medications called fibrates. Included in this class are gemfibrozil (Lopid) and fenofibrate (Tricor). Similar to statins, fibrates are safe and effective but may cause muscle damage, usually when used in combination with other medications.
How serious is it?
What type of hyperlipidemia is it?
Is there an underlying cause of the hyperlipidemia?
What is its relationship to diabetes?
What treatment do you recommend?
If the treatment involves drugs, what side effects should I watch for?
What dietary changes do you recommend?
What weight reduction goals are reasonable?
Editorial review provided by VeriMed Healthcare Network.