Hyperlipidemia is a medical term for abnormally high levels of fats (lipids) in the blood, which include cholesterol and triglycerides. You can inherit it or develop it from lifestyle factors, including diet and too little physical activity.
The most common type of hyperlipidemia is high cholesterol. Other forms of hyperlipidemia include hypertriglyceridemia and mixed hyperlipidemia, in which both cholesterol and triglyceride levels are high.
Hyperlipidemia is very common, especially in modern developed countries. It’s also increasing around the world.
People with untreated hyperlipidemia are
Hyperlipidemia is usually quite manageable, though, and these emergency events can often be avoided. The key is an early diagnosis and treatment plan to prevent its progression.
Cholesterol is a fatty substance that travels through your bloodstream on proteins called lipoproteins.
When you have too much cholesterol in your blood, it can build up on the walls of your blood vessels and form plaque. Over time, plaque deposits grow larger and begin to clog up your arteries. This may lead to:
- heart disease
- heart attack
- peripheral artery disease, which can lead to limb ischemia or gangrene
There are two types of cholesterol, LDL and HDL. You’ve probably heard them called “bad” and “good” cholesterol, respectively.
LDL (“bad”) cholesterol builds up in your artery walls, making them hard and narrow. HDL (“good”) cholesterol cleans up excess “bad” cholesterol and moves it away from the arteries, back to your liver.
Hyperlipidemia is an imbalance of cholesterol in your blood caused by a combination of having too much LDL cholesterol and not enough HDL cholesterol to clear it up.
There are two main classifications of hyperlipidemia: familial and acquired. The familial type stems from genes you inherit from your parents.
The acquired type is the result of:
- underlying health conditions
- medications you take
- lifestyle choices
Acquired hyperlipidemia is most often the result of certain lifestyle factors. It may also result from medications you take or underlying health conditions.
Lifestyle causes of hyperlipidemia
Lifestyle factors can raise “bad” cholesterol levels and lower “good” cholesterol levels.
According to the
- an unbalanced diet
- insufficient exercise
- smoking or regular exposure to secondhand smoke
- overweight or obesity
- heavy alcohol use (though drinking moderate amounts of red wine
may have a positive effect)
Health conditions that contribute to hyperlipidemia
Certain health conditions can also contribute to high cholesterol levels, including:
Other inherited conditions and pregnancy may also contribute to high cholesterol.
Medications that contribute to hyperlipidemia
Your cholesterol levels may sometimes be affected by certain medications, such as:
Beta-blockers rarely affect cholesterol levels, and often not enough to merit stopping the medications.
Familial combined hyperlipidemia
Familial combined hyperlipidemia (or mixed hyperlipidemia) is a type that you can inherit from your parents or grandparents. It causes high cholesterol and high triglyceride levels.
People with familial combined hyperlipidemia often develop high cholesterol or high triglyceride levels in their teens and receive a diagnosis in their 20s or 30s. This condition increases chances of early coronary artery disease and heart attack.
Unlike people with typical hyperlipidemia, people with familial combined hyperlipidemia may experience symptoms of cardiovascular disease early in life, such as:
Hyperlipidemia usually does not show symptoms until it has advanced to the state where people have emergency complications, such as a heart attack or stroke. These can occur when high cholesterol has led to plaque buildup in your arteries that limits or blocks the flow of blood.
A simple blood test will let you and your doctor know your blood cholesterol levels.
- every 5 years if you are at low risk for cardiovascular disease
- more frequently than every 5 years if you have cardiovascular disease risk factors
Sometimes, tests are appropriate for children and adolescents. The CDC points out that
Check with your doctor about a cholesterol test for your child if:
- your family has a history of early heart attacks or heart disease
- your child has excess weight or obesity
- your child has diabetes
Hyperlipidemia has no symptoms, so the only way to detect it is to have your doctor request a blood test called a lipid panel or a lipid profile. Your doctor will use your lipid panel to make a hyperlipidemia diagnosis.
This test determines your cholesterol levels. A healthcare professional will take a sample of your blood and send it to a lab for testing, then get back to you with a full report. Your report will show your levels of:
- total cholesterol
- low-density lipoprotein (LDL) cholesterol
- high-density lipoprotein (HDL) cholesterol
Your doctor may ask you to fast for 8 to 12 hours before getting your blood drawn. That means you’ll need to avoid eating or drinking anything other than water during that time. However, recent studies suggest that fasting isn’t always necessary, so follow your doctor’s instructions.
Safe levels of cholesterol can vary from person to person depending on health history and current health concerns and are best determined with your doctor.
Lifestyle changes are the first line of treatment for hyperlipidemia. If these are insufficient, your doctor may prescribe medications to help manage your high cholesterol.
Lifestyle changes are often key to managing hyperlipidemia at home. Even if your hyperlipidemia is inherited (familial combined hyperlipidemia), lifestyle changes are still an essential part of treatment.
These changes alone may be enough to reduce your risk of complications like heart disease and stroke.
If you’re already taking medications to manage hyperlipidemia, lifestyle changes can improve their cholesterol-lowering effects.
Eat a heart healthy diet
Making changes to your diet can lower your LDL cholesterol levels and increase your HDL cholesterol levels. Here are a few changes you can make:
- Choose healthier fats. Avoid saturated fats that are found primarily in red meat, bacon, sausage, and full-fat dairy products. Choose leaner proteins like chicken, turkey, and fish when possible. Use monounsaturated fats like olive, avocado, and canola oil for cooking.
- Cut out the trans fats. Trans fats are found in fried food and processed foods, like cookies, crackers, and other snacks. Check the ingredients on product labels. Skip any product that lists “partially hydrogenated oil.”
- Eat more omega-3s. Omega-3 fatty acids have many heart benefits. You can find them in some types of fish, including salmon, mackerel, and herring. They can also be found in some nuts and seeds, like walnuts and flaxseeds.
- Increase your fiber intake. All fiber is heart healthy, but soluble fiber, which is found in oats, bran, fruits, beans, and vegetables,
can loweryour LDL cholesterol levels.
- Learn heart healthy recipes. Check out the
American Heart Association’s recipe pagefor tips on delicious meals, snacks, and desserts that won’t raise your cholesterol.
- Eat more fruits and veggies. They’re high in fiber and vitamins and low in saturated fat.
Maintain a healthy-for-you weight
If you have high body weight or obesity, losing weight may help lower your total cholesterol levels.
Losing weight starts with figuring out how many calories you’re taking in and how many you’re burning. For a typical adult, it takes cutting 3,500 calories from your diet to lose about a pound.
You don’t have to start this process alone, though. You can work with a doctor or registered dietitian to create an eating plan that works for you, along with increasing physical activity so you’re burning more calories than you’re eating.
Get active, if you can
Physical activity is important for overall health, weight loss, and cholesterol levels. When you aren’t getting enough physical activity, your HDL cholesterol levels go down. This means there isn’t enough “good” cholesterol to carry the “bad” cholesterol away from your arteries.
You only need 40 minutes of moderate to vigorous exercise 3 or 4 times a week to lower your total cholesterol levels. The goal should be 150 minutes of total exercise each week.
This can look like anything you enjoy doing, but some of the following can help you add exercise to your daily routine:
- Try biking to work.
- Take brisk walks with your dog.
- Swim laps at the local pool.
- Join a gym (and use it!).
- Take the stairs instead of the elevator.
- If you use public transportation, get off a stop or two sooner.
Seek strategies to stop smoking
Smoking lowers your “good” cholesterol levels and raises your triglycerides. Even if you haven’t been diagnosed with hyperlipidemia, smoking can increase your risk of heart disease.
Talk with your doctor about quitting, or try the nicotine patch. Nicotine patches are available at the pharmacy without a prescription.
If lifestyle changes aren’t enough to treat your hyperlipidemia, your doctor may prescribe medication.
Statins are the first line medication for hyperlipidemia. If you cannot tolerate statins or if they do not reduce your LDL cholesterol enough, mRNA and monoclonal antibody drugs have been developed recently.
Common cholesterol- and triglyceride-lowering medications include:
- statins, such as:
- bile-acid-binding resins, such as:
- cholesterol absorption inhibitors, such as ezetimibe (Zetia/Nexlizet)
- injectable alternatives to statins, such as alirocumab (Praluent) or evolocumab (Repatha)
- fibrates, like fenofibrate (Fenoglide, Tricor, Triglide) or gemfibrozil (Lopid)
- niacin (Niacor)
- omega-3 fatty acid supplements
- other cholesterol lowering supplements
New medications for high cholesterol
Clinical trials in 2020 showed the drug could cut levels of LDL cholesterol by 50 percent in people who are either intolerant or resistant to standard statin medications.
Inclisiran is the pioneer cholesterol drug in what’s called “small interfering RNA therapy.” This is a type of drug that blocks, or interferes with, the function of an RNA messenger (mRNA). An mRNA is a molecule that carries code for making a particular protein.
In the case of Inclisiran, the drug blocks, or interferes with, the production of an enzyme called PCSK9 (proprotein convertase subtilisin kexin type 9). This enzyme causes problems with the LDL receptors in the liver that are necessary for the uptake of LDL cholesterol by liver cells.
By blocking PCSK9 activity, Inclisiran helps the body reduce the amount of LDL cholesterol. The drug is intended for hyperlipidemia treatment in adults whose high LDL cholesterol persists even while they’re on a maximum tolerated dose of statin therapy.
Bempedoic acid (Nexlitol) and ezetimibe (Nexlizet)
The two drugs Nexlitol and Nexlizet, approved by the FDA in 2020, are the first new non-statin cholesterol drugs approved by the FDA since 2002.
Nexlizet contains ezetimibe, which lowers cholesterol by preventing the body from absorbing cholesterol from foods. It’s also designed to be taken along with statins.
Both Nexlitol and Nexlizet can cause serious side effects. Your doctor can help you decide if one of these drugs would benefit your treatment plan.
Praluent was originally approved by the FDA in 2015 for treating heart disease and primary inherited hyperlipidemia. It was then the first PCSK9 inhibitor approved by the FDA.
PCSK9 inhibitor drugs work by attaching to the PCSK9 gene to prevent it from degrading LDL receptors in the liver that help lower LDL cholesterol in the body. This differs from the new mRNA drug Inclirisan, in that inhibitors attach to the PCSK9 gene, whereas the mRNA drug prevents PCSK9 from being produced.
Alirocumab, the active drug in Praluent, is a monoclonal antibody. This is a protein synthesized in a laboratory that behaves like antibodies made by the human body.
Praluent comes as a liquid solution in a prefilled pen. You deliver it as an injection every 2 to 4 weeks, which can be done at home. It has a number of reported possible side effects, so be sure to discuss with your doctor whether it would suit your treatment plan.
You can make changes to your lifestyle to prevent high cholesterol or reduce your risk of developing hyperlipidemia:
- Exercise several days per week, if you can.
- Eat a diet lower in saturated and trans fats.
- Include lots of fruits, vegetables, beans, nuts, whole grains, and fish regularly into your diet.
- Limit red meat and processed meats like bacon, sausage, and cold cuts.
- Maintain a weight that’s healthy for you.
- Eat lots of healthy fats, like avocado, almonds, and olive oil.
You may want to try a heart healthy eating plan like the Mediterranean diet, which includes a lot of the nutritious foods mentioned above.
People with untreated hyperlipidemia have double the risk of developing coronary heart disease as those with normal-range cholesterol levels. Coronary heart disease can lead to heart attack, stroke, or other serious problems.
Hyperlipidemia is very treatable, however, and complications can often be avoided.
You may be able to prevent complications and manage hyperlipidemia by making lifestyle choices, like:
- eating a balanced and nutrient-dense diet
- exercising regularly
- not smoking
- maintaining a healthy weight for you
If lifestyle choices are not sufficient, you can talk with your doctor about adding medications such as statins to help bring your cholesterol and triglycerides down to healthy levels.