What is dyslipidemia? (High Cholesterol)

Dyslipidemia occurs when someone has abnormal levels of lipids in their blood. While the term describes a wide range of conditions, the most common forms of dyslipidemia involve:

• high levels of low-density lipoproteins (LDL), or bad cholesterol
• low levels of high-density lipoproteins (HDL), or good cholesterol
• high levels of triglycerides
• high cholesterol, which refers to high LDL and triglyceride levels

Lipids, or fats, are building blocks of life and provide energy to cells. Lipids include:

• LDL cholesterol, which is considered bad because it can cause plaques to form in the blood vessels.
• HDL cholesterol, which is regarded as good because it can help to remove LDL from the blood.
• Triglycerides, which develop when calories are not burned right away and are stored in fat cells.

Healthy blood lipid levels naturally vary from person to person. However, people with high levels of LDL and triglycerides or very low HDL levels tend to have a higher risk of developing atherosclerosis.

Atherosclerosis develops when hard, fatty deposits called plaques accumulate in blood vessels, making it difficult for blood to flow.

Over time, these plaques can build up and cause major circulation problems, such as heart attacks and strokes.

Symptoms

Unless it is severe, most people with dyslipidemia are unaware that they have it. A doctor will usually diagnose dyslipidemia during a routine blood test or a test for another condition.

Severe or untreated dyslipidemia can lead to other conditions, including coronary artery disease (CAD) and peripheral artery disease (PAD).

Both CAD and PAD can cause serious health complications, including heart attacks and strokes. Common symptoms of these conditions include:

• leg pain, especially when walking or standing
• chest pain
• tightness or pressure in the chest and shortness of breath
• pain, tightness, and pressure in the neck, jaw, shoulders, and back
• indigestion and heartburn
• sleep problems and daytime exhaustion
• dizziness
• heart palpitations
• cold sweats
• vomiting and nausea
• swelling in the legs, ankles, feet, stomach, and veins of the neck
• fainting

These symptoms may get worse with activity or stress and get better when a person rests.

Talk with a doctor about chest pain, especially any of the above symptoms accompany it.

Anyone who experiences severe chest pain, dizziness, and fainting, or problems breathing should seek emergency care.

Types and causes

Dyslipidemia can be categorized into two types, based on the cause:

Primary dyslipidemia

Genetic factors cause primary dyslipidemia, and it is inherited. Common causes of primary dyslipidemia include:

• Familial combined hyperlipidemia, which develops in teenagers and young adults and can lead to high cholesterol.
• Familial hyperapobetalipoproteinemia, a mutation in a group of LDL lipoproteins called apolipoproteins.
• Familial hypertriglyceridemia, which leads to high triglyceride levels.
• Homozygous familial or polygenic hypercholesterolemia, a mutation in LDL receptors.

Secondary dyslipidemia

Secondary dyslipidemia is caused by lifestyle factors or medical conditions that interfere with blood lipid levels over time.

Common causes of secondary dyslipidemia include:

• obesity, especially excess weight around the waist
• diabetes
• hypothyroidism
• alcohol use disorder, also known as alcoholism
• polycystic ovary syndrome
• metabolic syndrome
• excessive consumption of fats, especially saturated and trans fats
• Cushing’s syndrome
• inflammatory bowel disease, commonly known as IBS
• severe infections, such as HIV
• an abdominal aortic aneurysm

Risk factors

Several factors are known to increase the chances of developing dyslipidemia and related conditions. These risk factors include:

• obesity
• a sedentary lifestyle
• a lack of regular physical exercise
• alcohol use
• tobacco use
• use of illegal or illicit drugs
• sexually transmitted infections
• type 2 diabetes
• hypothyroidism
• chronic kidney or liver conditions
• digestive conditions
• older age
• a diet rich in saturated and trans fats
• a parent or grandparent with dyslipidemia
• female sex, as women tend to experience higher LDL levels after menopause

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Treatment

A doctor will usually focus on lowering a person’s levels of triglycerides and LDL. However, treatment can vary, depending on the underlying cause of dyslipidemia and how severe it is.

Doctors may prescribe one or more lipid-modifying medications for people with very high total cholesterol levels of at least 200 milligrams per deciliter of blood.

High cholesterol is usually treated with statins, which interfere with the production of cholesterol in the liver.

If statins fail to lower LDL and triglyceride levels, a doctor may recommend additional medications, including:

• ezetimibe
• niacin
• fibrates
• bile acid sequestrants
• evolocumab and alirocumab
• lomitapide and mipomersen

Some lifestyle changes and supplements can help to encourage healthy blood lipid levels.

Natural treatments include:

• reducing the consumption of unhealthy fats, such as those found in red meats, full-fat dairy products, refined carbohydrates, chocolate, chips, and fried foods
• exercising regularly
• maintaining a healthy body weight, by losing weight if necessary
• reducing or avoiding alcohol consumption
• quitting smoking and other use of tobacco products
• avoiding sitting for long periods of time
• increasing consumption of healthy polyunsaturated fats, such as those found in nuts, seeds, legumes, fish, whole grains, and olive oil
• taking omega-3 oil, either as a liquid or in capsules
• eating plenty of dietary fiber from whole fruits, vegetables, and whole grains
• getting at least 6– 8 hours of sleep a night
• drinking plenty of water

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