Dyslipidemia

Dyslipidemia is an imbalance of waxy, fat-like substances (lipids) in the blood. The body needs lipids in small amounts. Dyslipidemia often involves a high level of cholesterol or triglycerides, which are types of lipids.

• High levels of LDL cholesterol. LDL is the type of cholesterol that causes fatty deposits (plaques) to build up in the blood vessels that carry blood away from the heart (arteries).
• Low levels of HDL cholesterol. HDL cholesterol is the type of cholesterol that protects against heart disease. High levels of HDL remove the LDL buildup from arteries.
• High levels of triglycerides. Triglycerides are a fatty substance in the blood that is linked to a buildup of plaques in the arteries.

What are the causes?

There are two main types of dyslipidemia: primary and secondary. Primary dyslipidemia is caused by changes (mutations) in genes that are passed down through families (inherited). These mutations cause several types of dyslipidemia.

Secondary dyslipidemia may be caused by various risk factors that can lead to the disease, such as lifestyle choices and certain medical conditions.

What increases the risk?

• Having a family history of dyslipidemia.
• Taking certain medicines, including birth control pills, steroids, some diuretics, and beta-blockers.
• Eating a diet high in saturated fat.
• Smoking cigarettes or excessive alcohol intake.
• Having certain medical conditions such as diabetes, polycystic ovary syndrome (PCOS), kidney disease, liver disease, or hypothyroidism.
• Not exercising regularly.
• Being overweight or obese with too much belly fat.

What are the signs or symptoms?

In most cases, dyslipidemia does not usually cause any symptoms.

• Fatty bumps under the skin (xanthomas).
• A white or gray ring around the black center (pupil) of the eye.

Very high triglyceride levels can cause inflammation of the pancreas (pancreatitis).

How is this diagnosed?

• Total cholesterol. This measures the total amount of cholesterol in your blood, including LDL cholesterol, HDL cholesterol, and triglycerides. A healthy number is below 200 mg/dL (5.17 mmol/L).
• LDL cholesterol. The target number for LDL cholesterol is different for each person, depending on individual risk factors. A healthy number is usually below 100 mg/dL (2.59 mmol/L). Ask your health care provider what your LDL cholesterol should be.
• HDL cholesterol. An HDL level of 60 mg/dL (1.55 mmol/L) or higher is best because it helps to protect against heart disease. A number below 40 mg/dL (1.03 mmol/L) for men or below 50 mg/dL (1.29 mmol/L) for women increases the risk for heart disease.
• Triglycerides. A healthy triglyceride number is below 150 mg/dL (1.69 mmol/L).

If your lipid profile is abnormal, your health care provider may do other blood tests.

How is this treated?

Treatment depends on the type of dyslipidemia that you have and your other risk factors for heart disease and stroke. Your health care provider will have a target range for your lipid levels based on this information.

• Get regular exercise.
• Make changes to your diet.
• Quit smoking if you smoke.
• Limit your alcohol intake.

If diet changes and exercise do not help you reach your goals, your health care provider may also prescribe medicine to lower lipids. The most commonly prescribed type of medicine lowers your LDL cholesterol (statin drug). If you have a high triglyceride level, your provider may prescribe another type of drug (fibrate) or an omega-3 fish oil supplement, or both.

Follow these instructions at home:

Eating and drinking

• Follow instructions from your health care provider or dietitian about eating or drinking restrictions.
• Eat a healthy diet as told by your health care provider. This can help you reach and maintain a healthy weight, lower your LDL cholesterol, and raise your HDL cholesterol. This may include:
  • Limiting your calories, if you are overweight.
  • Eating more fruits, vegetables, whole grains, fish, and lean meats.
  • Limiting saturated fat, trans fat, and cholesterol.
• Do not drink alcohol if:
  • Your health care provider tells you not to drink.
  • You are pregnant, may be pregnant, or are planning to become pregnant.
• If you drink alcohol:
  • Limit how much you have to:
    • 0–1 drink a day for women.
    • 0–2 drinks a day for men.
  • Know how much alcohol is in your drink. In the U.S., one drink equals one 12 oz bottle of beer (355 mL), one 5 oz glass of wine (148 mL), or one 1½ oz glass of hard liquor (44 mL).

Activity

• Get regular exercise. Start an exercise and strength training program as told by your health care provider. Ask your health care provider what activities are safe for you. Your health care provider may recommend:
  • 30 minutes of aerobic activity 4–6 days a week. Brisk walking is an example of aerobic activity.
  • Strength training 2 days a week.

General instructions

• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider. This includes supplements.
• Keep all follow-up visits. This is important.

Contact a health care provider if:

• You are having trouble sticking to your exercise or diet plan.
• You are struggling to quit smoking or to control your use of alcohol.

Summary

• Dyslipidemia often involves a high level of cholesterol or triglycerides, which are types of lipids.
• Treatment depends on the type of dyslipidemia that you have and your other risk factors for heart disease and stroke.
• Treatment for dyslipidemia starts with lifestyle changes, such as diet and exercise.
• Your health care provider may prescribe medicine to lower lipids.