Dyslipidemia
Dyslipidemia is an abnormal lipid profile, chiefly elevated LDL cholesterol, that drives atherosclerotic cardiovascular disease. Management is risk-based LDL lowering with statins as the foundation, adding ezetimibe and PCSK9 inhibitors to reach targets, alongside lifestyle change and evaluation for severe genetic forms and hypertriglyceridemia.
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What this article covers
- Overview
Definition: dyslipidemia is an abnormal serum lipid profile, most importantly elevated low-density lipoprotein (LDL) cholesterol, but also high triglycerides and low HDL cholesterol.
- Epidemiology
Very common, and a leading modifiable cardiovascular risk factor.
- Risk factors
Diet high in saturated and trans fats, obesity, and inactivity.
- Pathophysiology
LDL retention and atherogenesis: elevated LDL particles enter and are retained in the arterial wall, initiating atherosclerosis.
- Clinical features
Usually asymptomatic. Signs of severe or genetic dyslipidemia: tendon xanthomas, xanthelasma, and corneal arcus (familial hypercholesterolemia).
- Differential diagnosis
Secondary dyslipidemia: an abnormal lipid profile from hypothyroidism, nephrotic syndrome, cholestasis, or drugs, which resolves when the underlying cause is treated rather than persisting as a primary lipid disorder.
- Diagnosis
Establish with a lipid panel and integrate into cardiovascular risk assessment, screening for genetic and secondary causes: the diagnostic basis is a fasting or non-fasting lipid panel (total, LDL…
- Management
First-line, lifestyle change and risk-based statin therapy: a heart-healthy diet, exercise, weight loss, and smoking cessation, with a statin dosed to risk (atorvastatin 40 to 80 mg PO once daily or…
- Complications
Atherosclerotic cardiovascular disease (coronary, cerebrovascular, peripheral).
- Prognosis
Cardiovascular risk falls substantially with LDL lowering.
- Prevention
Heart-healthy diet, exercise, and weight management, with lipid screening in adults every 4 to 6 years: saturated fat below 7% of calories, no trans fats, and at least 150 minutes/week of exercise.
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