Hyperlipidemia

Hyperlipidemia (high cholesterol) means you have too many lipids (fats) in your blood, which increases your risk of heart attack and stroke. Your liver creates cholesterol to help you digest food and make things like hormones. But you also eat cholesterol in meat and dairy products. Because your liver can make as much cholesterol as you need, the cholesterol in foods you eat is extra.

High levels of cholesterol in the blood may lead to a buildup of plaque in your blood vessels, particularly arteries. As plaque builds up in an artery, it gradually reduces the amount of blood that can flow through that artery. As a result, some organs may not receive enough blood. Over time, this can result in permanent damage to those organs.

Bad cholesterol (LDL) is the most dangerous type because it causes deposits of cholesterol and fats (plaque) to collect inside of your blood vessels. This makes it harder for your blood to get through.

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

• Low-density lipoprotein (LDL) can clog your arteries like a large truck that broke down and is blocking a traffic lane.
• Very low-density lipoprotein (VLDL) 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. In this case, it clears the way for blood to get through your blood vessels.

Hyperlipidemia is a very common cause of heart and blood vessel disease, which remains the leading cause of death in the U.S.

Symptoms of hyperlipidemia

High cholesterol doesn’t cause symptoms directly. But it plays a role in developing coronary artery disease that leads to chest pain, for example. Over time, plaque buildup can slow down or stop blood flow to your heart or brain. You may feel chest pain with exertion, jaw pain and shortness of breath.

Plaque in a heart artery can lead to a heart attack, with symptoms like severe chest pain, flushing, nausea and difficulty breathing. This is a medical emergency.

People who have a genetic problem that causes very high cholesterol levels may get xanthomas (waxy, fatty plaques on their skin) or corneal arcus (cholesterol rings around the irises of their eyes).

Hyperlipidemia causes

Many different things can cause high cholesterol. Some are beyond your control. Others are factors you can change.

Causes include:

• Daily habits: These include smoking, not getting enough physical activity, eating foods with saturated or trans fats and being overly stressed.
• Genetics: Certain conditions you inherit, like familial hypercholesterolemia, make your bad (LDL) cholesterol number extremely high.
• Medications: Medicines to treat and prevent HIV, antipsychotics, antiepileptics and anabolic steroids can affect your cholesterol levels.
• Medical conditions: Obesity, diabetes, lupus, sleep apnea, HIV, thyroid disease, PCOS or chronic kidney disease can also affect how much cholesterol you have.

Risk factors

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

• Having a family history of high cholesterol
• Being over age 40
• Being white, Hispanic or Asian American
• Being male
• Being a postmenopausal female

Complications of this condition

Without treatment, high cholesterol can let plaque collect inside your body’s blood vessels (atherosclerosis). This can bring on complications that include:

• Heart attack
• Stroke
• Coronary heart disease
• Carotid artery disease
• Sudden cardiac arrest
• Peripheral artery disease
• Small vessel disease
• High blood pressure

How doctors diagnose this condition

Your provider will order a blood test to check the cholesterol levels in your blood. They can help you interpret your numbers and prescribe a treatment tailored to you.

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

• Total cholesterol: Should be less than 200 milligrams per deciliter (mg/dL)
• Bad (LDL) cholesterol: Should be less than 100 mg/dL
• Good (HDL) cholesterol: Should be at least 60 mg/dL
• Triglycerides: Should be less than 150 mg/dL

Your provider will also do a physical exam and ask about your personal and family medical history. They may also do these tests:

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

High cholesterol can start in childhood or adolescence. That’s why current guidelines suggest it might be reasonable to screen all children for high cholesterol. The guidelines are:

• Children and teens: Get a blood test every five years starting at age 9. A child whose parents have high cholesterol or a history of heart problems may begin even sooner.
• Males: Get a blood test every five years until age 45. From age 45 to 65, get checked every one to two years. After age 65, get checked every year.
• Females: Get a blood test every five years until age 55. From age 55 to 65, get checked every one to two years. After age 65, get checked every year.

These are general guidelines. Talk to your healthcare provider about the right time to check your cholesterol levels. Someone in their 20s with high cholesterol numbers may need yearly tests for a while. People with other heart disease risk factors may need more frequent tests, too.

How is it treated?

You may be able to just change your daily habits to improve your high cholesterol levels. If that’s not enough, you may need medication. People who need medicine to treat their high cholesterol usually take statins. These decrease how much bad cholesterol is circulating in your blood. Your provider may order a different type of medicine if you can’t take a statin or need another medicine in addition to a statin.

Things you can do include:

• Be physically active
• Quit smoking
• Sleep at least seven hours each night
• Manage your stress level
• Eat heart-healthy foods
• Limit how much alcohol you drink
• Stay at a weight that’s healthy for you

When should I see my healthcare provider?

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

Questions to ask your provider may include:

• Do I need to make changes to daily habits, 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?

What can I expect if I have this condition?

Although high cholesterol puts you at risk for heart attacks and stroke, you can protect yourself. Making a few changes in your daily routine and taking medicine if needed can help. Talk to your provider about estimating your risk of heart disease and stroke so they can help you manage your risk.

Hyperlipidemia is a condition you’ll need to manage for the rest of your life. You’ll need to keep using healthy habits for years to come. You’ll also need to have follow-up visits with your provider and continue to take your medicine. If you and your provider are able to manage your cholesterol level, you may not have serious health problems from it.

Can this be prevented?

Changes you make in your daily habits 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 nutritious foods.
• Cut back on eating fatty meats.
• Don’t buy snacks that have “trans fat” on the label.
• Stay at a weight that’s healthy for you.