Hyperlipidemia

Hyperlipidemia (high cholesterol) means your blood has too many lipids (fats) in it. These can add up and lead to blockages in your blood vessels. This is why high cholesterol can put you at risk for a stroke or heart attack. But you can make lifestyle changes like eating healthier and exercising to lower your cholesterol. Medicine can help, too.

  Hyperlipidemia, or high cholesterol, can let plaque collect inside your blood vessels and put you at risk of a heart attack or stroke. The good news is that you have the power to reduce your risk of heart attack and stroke. Exercising more and eating healthier are just two of the ways you can improve your cholesterol numbers. Taking medicine your provider orders makes a difference, too.

OVERVIEW

Bad cholesterol (LDL) and plaque in an artery

What is hyperlipidemia?

Hyperlipidemia, also known as dyslipidemia or high cholesterol, means you have too many lipids (fats) in your blood. Your liver creates cholesterol to help you digest food and make things like hormones. But you also eat cholesterol in foods from the meat and dairy aisles. Since your liver can make as much cholesterol as you need, the cholesterol in foods you eat is extra.

Too much cholesterol (200 to 239 mg/dL is borderline high and 240 mg/dL is high) is not healthy because it can create roadblocks in your artery highways where blood travels around to your body. This damages your organs. Bad cholesterol (LDL) is the most dangerous type because it causes hardened cholesterol deposits (plaque) to collect inside of your blood vessels. This makes it harder for your blood to get through, which puts you at risk for a stroke or heart attack.

Think of cholesterol, a kind of fat, as traveling in lipoprotein cars through your blood.

• Low-density lipoprotein (LDL) is known as bad cholesterol because it can clog your arteries like a large truck that broke down and is blocking a traffic lane. (Borderline high number: 130 to 159 mg/dL. High: 160 to 189 mg/dL.) 
• Very low density lipoprotein (VLDL) is also called bad because it carries triglycerides that add to artery plaque. This is another type of traffic blocker.
• High-density lipoprotein (HDL) is known as good cholesterol because it brings cholesterol to your liver, which gets rid of it. This is like the tow truck that removes the broken down vehicles from the traffic lanes so vehicles can move. In this case, it’s clearing the way for your blood to get through your blood vessels. For your HDL, you don’t want to have a number lower than 40 mg/dL.

It’s important to know that providers consider other factors in addition to your cholesterol numbers when they make treatment decisions.

Is hyperlipidemia the same as high cholesterol?

Yes, hyperlipidemia is another name for high cholesterol, and so is hypercholesterolemia.

What is dyslipidemia vs. hyperlipidemia?

They are mostly interchangeable terms for abnormalities in cholesterol. Your cholesterol can be “dysfunctional” (cholesterol particles that are very inflammatory or an abnormal balance between bad and good cholesterol levels) without being high. Both a high level of cholesterol and increased inflammation in “normal” cholesterol levels put you at increased risk for heart disease.

What are the risk factors for hyperlipidemia? 

Several things can put you at a higher risk of hyperlipidemia, including:

• Having a family history of high cholesterol.
• Having hypothyroidism.
• Having obesity.
• Not eating a nutritious diet.
• Drinking too much alcohol.
• Having diabetes.
• Smoking.

How common is hyperlipidemia?

Hyperlipidemia is very common. Ninety-three million American adults (age 20 and older) have a total cholesterol count above the recommended limit of 200 mg/dL.

How serious is hyperlipidemia?

Hyperlipidemia can be very serious if it’s not controlled. As long as high cholesterol is untreated, you’re letting plaque accumulate inside your blood vessels. This can lead to a heart attack or stroke because your blood has a hard time getting through your blood vessels. This deprives your brain and heart of the nutrients and oxygen they need to function. Cardiovascular disease is the leading cause of death in Americans.

How does hyperlipidemia affect my body?

Hyperlipidemia (high cholesterol) that’s not treated can allow plaque to collect inside your body’s blood vessels (atherosclerosis). This can bring on hyperlipidemia complications that include:

• Heart attack.
• Stroke.
• Coronary heart disease.
• Carotid artery disease.
• Sudden cardiac arrest.
• Peripheral artery disease.
• Microvascular disease.

SYMPTOMS AND CAUSES

What are the symptoms of hyperlipidemia?

Most people don’t have symptoms when their cholesterol is high. People who have a genetic problem with cholesterol clearance that causes very high cholesterol levels may get xanthomas (waxy, fatty plaques on the skin) or corneal arcus (cholesterol rings around the iris of the eye). 

What causes hyperlipidemia?

Various hyperlipidemia causes include:

• Smoking.
• Drinking a lot of alcohol.
• Eating foods that have a lot of saturated fats or trans fats. 
• Sitting too much instead of being active.
• Being stressed.
• Inheriting genes that make your cholesterol levels unhealthy.
• Being overweight.

Medications that are helpful for some problems can make your cholesterol levels fluctuate, such as:

• Beta blockers.
• Diuretics.
• Hormonal birth control.
• Steroids.
• Antiretrovirals for HIV.

Medical problems can also affect how much cholesterol you have. These include:

• Multiple myeloma.
• Polycystic ovary syndrome (PCOS).
• Hypothyroidism.
• Primary biliary cirrhosis.
• Chronic kidney disease.
• Diabetes.
• Lupus.
• Sleep apnea.
• HIV.

DIAGNOSIS AND TESTS

How is hyperlipidemia diagnosed?

Your provider will want:

• A physical exam.
• Your medical history.
• Your family’s medical history.
• To calculate your 10 year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score.

A blood test called a lipid panel will tell you these numbers:

Type of cholesterol	Best number to have
Total cholesterol	Less than 200 mg/dL
Bad (LDL) cholesterol	Less than 100 mg/dL
Good (HDL) cholesterol	At least 60 mg/dL
Triglycerides	Less than 150 mg/dL

What tests will be done to diagnose hyperlipidemia?

Your provider may also do these tests:

• High sensitivity C-reactive protein (hs-CRP).
• Lipoprotein (a).
• Apolipoprotein B.
• Coronary calcium scan.

MANAGEMENT AND TREATMENT

How is hyperlipidemia treated?

Changing their lifestyles may be all some people need to do to improve their cholesterol numbers. For other people, that’s not enough and they need medication.

Things you can do include:

• Exercising.
• Quitting smoking.
• Sleeping at least seven hours each night.
• Keeping your stress level under control.
• Eating healthier foods.
• Limiting how much alcohol you drink.
• Losing a few pounds to reach a healthy weight.

What medications are used for hyperlipidemia?

People who need medicine to treat their high cholesterol usually take statins. Your provider may order a different type of medicine if:

• You can’t take a statin.
• You need another medicine in addition to a statin.
• You have familial hypercholesterolemia, a genetic problem that makes your bad (LDL) cholesterol number extremely high.

Are there side effects of hyperlipidemia treatment?

Any medication can have side effects, but the benefits of statins far outweigh the risks of minor side effects. Let your provider know if you aren’t doing well on your medicine so they can develop a plan to manage your symptoms.

How soon will the hyperlipidemia treatment start working?

Your provider will order another blood test about two or three months after you start taking hyperlipidemia medication. The test results will show if your cholesterol levels have improved, which means the medicine and/or lifestyle changes are working.

PREVENTION

How can I reduce my risk of hyperlipidemia?

Even children can get their blood checked for high cholesterol, especially if someone in the child’s family had a heart attack, stroke or high cholesterol. Children and young adults can get checked every five years.

Once you reach middle age, you should have your cholesterol checked every year or two. Your healthcare provider can help you decide how often you should have a hyperlipidemia screening.

How can I prevent hyperlipidemia?

Changes you make in your life can keep you from getting hyperlipidemia. Things you can do include:

• Stop smoking.
• Stay active instead of sitting too much.
• Keep your stress level down.
• Get the right amount of sleep.
• Eat healthy foods.
• Cut back on eating fatty meats.

• Don’t buy snacks that have “trans fat” on the label.
• Stay at a healthy weight.

OUTLOOK / PROGNOSIS

What can I expect if I have hyperlipidemia?

If you have hyperlipidemia, you’ll need to keep using healthy lifestyle habits for years to come. You’ll also need to keep follow-up appointments with your provider and continue to take your medicine.

How long will you have hyperlipidemia?

Hyperlipidemia is a condition you’ll need to manage for the rest of your life.

What is the outlook for hyperlipidemia? 

Although high cholesterol puts you at risk for heart attacks and stroke, you can protect yourself by living a healthier lifestyle and taking medicine if needed.

LIVING WITH

How do I take care of myself with hyperlipidemia? 

Be sure to follow your provider’s instructions for making your lifestyle healthier.

Here are things you can do yourself:

• Exercise.
• Stop smoking.
• Sleep at least seven hours each night.
• Control your stress level.
• Eat healthier foods.
• Limit how much alcohol you drink.
• Stay at a healthy weight.

Other things you can do:

• If your provider ordered medicine for you, be sure to keep taking it as the label tells you to do. 
• Keep your follow-up appointments.

When should I see my healthcare provider?

You should see your provider if you have:

• High blood sugar.
• High blood pressure.
• High cholesterol.

What questions should I ask my doctor?

• Do I need to make lifestyle changes, take medication or both?
• If I do what you tell me to do, how quickly can my numbers improve?
• How often do I need to check in with you? 

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