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Dyslipidemia describes abnormal levels of fatty compounds in your blood known as lipids that can contribute to your risk of heart disease. The main goal of treatment is to lower low-density lipoprotein (LDL) cholesterol, raise high-density lipoprotein (HDL) cholesterol, and reduce triglycerides.
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What Are the Types of Dyslipidemia?
In dyslipidemia, one or several lipids are either too high or too low. The four values commonly checked are:
- LDL cholesterol: Considered “bad” cholesterol, LDL can form hardened plaques on the walls of arteries and reduce blood flow.
- HDL cholesterol: Considered “good” cholesterol, HDL helps remove LDL from the blood and prevents plaque formation.
- Triglycerides: These lipids contribute to plaque formation by causing inflammatory damage to the walls of arteries.
- Total cholesterol: This is the sum of LDL, HDL, and half of the triglycerides. The value is an important indicator of the risk of cardiovascular disease.
Forms include hyperlipidemia, in which one or several lipid levels are abnormally high, or hypolipidemia, in which one or several lipid levels are abnormally low. Both are associated with an increased risk of cardiovascular disease.
Depending on which lipids are high or low, your condition may be diagnosed in one of the following ways:
| LDL | HDL | Triglycerides | |
|---|---|---|---|
| Hypercholesterolemia | High | Normal | Normal |
| Hypertriglyceridemia | Normal | Normal | High |
| Hypoalphalipoproteinemia | Normal | Low | Normal |
| Combined (or mixed) hyperlipidemia | High | Usually low | High |
What Are the Causes and Risk Factors?
Primary Dyslipidemia
Primary dyslipidemia is inherited and caused by genetic mutations (changes to the DNA sequence) that affect lipid metabolism (how lipids are produced, utilized, and broken down). The main risk factor is a family history of dyslipidemia or cardiovascular disease.
Examples of primary dyslipidemia include:
- Familial combined hyperlipidemia: This is the most common inherited cause of high LDL and triglycerides. Because the condition is inherited, it can cause problems as early as your teens. One or both genetic parents (those who contributed the egg or sperm) may pass the mutation to a child.
- Familial hypercholesterolemia: This is when your total cholesterol is elevated. Familial hypercholesterolemia is an autosomal dominant disorder, meaning that you inherit a single gene mutation from one genetic parent who also has the condition.
- Polygenic hypercholesterolemia: This also causes high total cholesterol but is due to multiple genetic mutations rather than one. People with these mutations are more vulnerable to high cholesterol when faced with factors like an unhealthy diet or obesity.
Primary dyslipidemia cannot be cured, but it can be effectively managed with treatment.
Secondary Dyslipidemia
Secondary dyslipidemia is acquired and caused by lifestyle or medical conditions that affect lipid metabolism. These conditions may affect hormones involved in lipid production, the breakdown of lipids in the liver, or the clearance of lipids from the body.
Risk factors include:
Unlike primary dyslipidemia, many of these risk factors are modifiable, meaning the person may be able to normalize cholesterol and triglyceride levels.
Symptoms and Cardiovascular Disease Complications
Dyslipidemia usually causes no symptoms, and most people do not realize they have it until they are tested. Any symptoms experienced would likely be due to complications of dyslipidemia, most commonly cardiovascular diseases affecting the heart and circulatory system.
The imbalance of lipids contributes to this in different ways. High LDL is the main factor for the formation of plaque in the arteries. Low HDL leads to an increase of LDL in the blood. High triglycerides damage arterial walls, enabling the formation of plaques.
Together, these mechanisms contribute to diseases like:
- Atherosclerosis: This is the narrowing and stiffening of arteries that reduce circulation and contribute to high blood pressure.
- Coronary artery disease (CAD): This is when atherosclerosis affects the main artery nourishing the heart muscle, called the coronary artery.
- Heart attack: Also known as a myocardial infarction, this can occur when a piece of plaque breaks off, forming a clot that can travel to the heart and cause an obstruction.
- Peripheral artery disease (PAD): This is when atherosclerosis develops in the arteries of the arms and legs, called the peripheral arteries.
- Stroke: Also known as cerebrovascular ischemia, this is when a clot from a disrupted plaque blocks a blood vessel in the brain.
How It Is Diagnosed
Dyslipidemia is diagnosed with a blood test called a lipid profile that measures the volumes of lipids in a sample of blood, both individually and in total. The results are compared to a reference range of values (high or low values in which results are considered normal).
The reference range, measured in milligrams per deciliter of blood (mg/dL), can vary by a person’s age, sex, and testing methods. However, in most people, normal levels can be described as follows:
| Age group | Type of cholesterol | Normal value |
|---|---|---|
| People 19 and under | LDL | Less than 110 mg/dL |
| HDL | More than 45 mg/dL | |
| Triglycerides | Less than 90 mg/dL | |
| Total cholesterol | Less than 200 mg/dL | |
| Males over 19 | LDL | Less than 100 mg/dL |
| HDL | More than 60 mg/dL (under 40 mg/dL is considered low) | |
| Triglycerides | Less than 150 mg/dL | |
| Total cholesterol | Less than 200 mg/dL | |
| Females over 19 | LDL | Less than 100 mg/dL |
| HDL | More than 60 mg/dL (under 50 mg/dL is considered low) | |
| Triglycerides | Less than 150 mg/dL | |
| Total cholesterol | Less than 200 mg/dL |
Lab interpretations can also vary based on a person’s age, sex, and health, with some results classified as “near-optimal” or “borderline” while others may be considered “high” or “very high.”
How Is Dyslipidemia Treated or Managed?
Lifestyle Modifications for Management and Prevention
Lifestyle modifications are considered the first-line approach to dyslipidemia, whether primary or secondary. In addition to managing dyslipidemia, these lifestyle changes can also help lower the risk of dyslipidemia. Key components include:
- A heart-healthy diet: Examples include the DASH (Dietary Approaches to Stop Hypertension) diet or the Mediterranean diet, which is rich in fruits and vegetables, soluble fibers like whole grains, sterols like olive oil and nuts, and omega-3 fatty acids in foods like fish. Alcohol and salt should be limited.
- Routine exercise: Experts recommend a minimum of 150 minutes of moderate-intensity exercise per week, exercising on most days of the week. Moderate intensity is when you can talk but not sing during a workout.
- Weight loss: If you are overweight, a 5% to 10% loss of body weight can dramatically improve your lipid profile. With a sustainable diet and exercise plan, you should aim to gradually decrease your body mass index (BMI), a measurement of body fat based on height and weight, closer to a level of 18.5 to 24.9.
- Smoking cessation: Current smoking can independently raise LDL levels by an average of 14% and triglyceride levels by an average of 20% while decreasing HDL by an average of 7%. Quitting can help reverse this.
Medications for Management
Prescription drugs may be prescribed if your risk of cardiovascular disease is increased. This is determined by an algorithm called the Framingham risk score which can calculate if you are at low risk (under 10%), intermediate risk (10% to 19%), or high risk (20% or more).
If treatment is indicated, it may involve different drugs or drug classes known as:
- Bile acid sequestrants, like Colestid (colestipol) and Welchol (colesevelam)
- Fibrates, like Atromid-S (clofibrate) and Lopid (gemfibrozil)
- Juxtapid (lomitapide)
- Nexlatol (bempedoic acid)
- PCSK9 inhibitors, like Praluent (alirocumab) and Repatha (evolocumab)
- Statins, like Lipitor (atorvastatin) and (Crestor (rosuvastatin)
- Vascepa (icosapent ethyl)
- Zetia (ezetimibe)
Routine blood tests and healthcare provider visits can increase your risk of treatment success. A 2021 study reported that doing so increases drug adherence rates by more than 300% compared to those who missed appointments or had infrequent visits.
When to See a Provider
Over 86 million adults in the United States have borderline high or high cholesterol. The risk extends even to children due to increasing rates of childhood obesity and poor dietary habits.
As a result, the Centers for Disease Control and Prevention (CDC) recommends that healthy adults have their lipids checked every four to six years. People with heart disease, diabetes, or a family history of high cholesterol need to be checked more frequently.
The CDC further advises that all children should have their cholesterol checked at least once between the ages of 9 and 11 and again as young adults between the ages of 17 and 21. Children with diabetes or obesity should have it checked more frequently.
Key Takeaways
- Dyslipidemia refers to abnormal levels of LDL cholesterol, HDL cholesterol, triglycerides, or total cholesterol in the blood.
- Having dyslipidemia can increase your risk of a heart attack or stroke by causing the formation of hardened plaques in your arteries. It may be inherited or acquired due to lifestyle factors like smoking or medical conditions like diabetes.
- Dyslipidemia can be diagnosed with a blood test and treated with lifestyle changes and medications if needed.
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