What Is Hyperlipidemia?

Cholesterol is a type of lipid--an essential element contained in all human cells. However,
excess lipids and other fatty substances in the blood can cause hyperlipidemia and other lipid
disorders. Hyperlipidemia is a significant risk factor for development of atherosclerosis and
heart disease.

A Healthy Cardiovascular System

The cardiovascular system comprises the heart, blood vessels, and blood. Blood has many life-
sustaining responsibilities, including transporting oxygen, carbon dioxide, nutrients, and
hormones throughout the body. Blood contains red blood cells, white blood cells, platelets, and
nutrients.
Cholesterol also circulates in the blood stream. Two common forms of cholesterol are LDL,
known as the 'bad cholesterol' and HDL, known as the 'good cholesterol.' Hyperlipidemia is the
term used when the blood contains a higher amount of LDL than is recommended.

Effects of Hyperlipidemia

Cholesterol and other fatty substances combine in the bloodstream and are deposited in the
blood vessels to form a material called plaque. The increase in lipids can cause plaques to
grow over time, leading to obstructions in blood flow. If an obstruction occurs in the coronary
arteries, it could result in a heart attack. And, if an obstruction occurs in the arteries of the
brain, it could lead to stroke.

Causes of Hyperlipidemia

Causes of hyperlipidemia can include heredity and taking certain medications. However, the
greatest, modifiable risk factor is diet; a poor diet is one with a fat intake greater than 40
percent of total calories, saturated fat intake greater than 10 percent of total calories; and
cholesterol intake greater than 300 milligrams per day.

Symptoms of Hyperlipidemia

There are no symptoms of hyperlipidemia, so regular cholesterol screening with blood tests
should be part of the physical examination. A doctor or healthcare professional can
recommend ways to prevent hyperlipidemia.

An excess of fats or lipids in the blood. Also called hyperlipemia.

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5min Related Video: hyperlipidemia

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Dental Dictionary: hyperlipidemia

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Home > Library > Health > Dental Dictionary

An excess of lipids in the plasma, including the glycolipids, lipoproteins, and

phospholipids.

Veterinary Dictionary: hyperlipidemia

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Home > Library > Animal Life > Veterinary Dictionary

A general term for elevated concentrations of any or all of the lipids in the plasma. See
also hyperlipoproteinemia.

• postprandial h. — a normal increase following ingestion of food.

• primary h. — caused by decreased activity of lipoprotein lipase, it occurs in
miniature Schnauzer dogs.
• secondary h. — may occur in association with diabetes mellitus, hypothyroidism,
pancreatitis, hyperadrenocorticism, cholestatic liver disease and nephrotic
syndrome.

Wikipedia: Hyperlipidemia
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Home > Library > Miscellaneous > Wikipedia
Hyperlipidemia
Classification and external
resources
ICD-10 E78.
ICD-9 272.0-272.4
DiseasesDB 6255
MeSH D006949

Hyperlipidemia, hyperlipoproteinemia or dyslipidemia is the presence of raised or

abnormal levels of lipids and/or lipoproteins in the blood. Lipids (fatty molecules) are
transported in a protein capsule, and the density of the lipids and type of protein
determines the fate of the particle and its influence on metabolism.

Lipid and lipoprotein abnormalities are extremely common in the general population, and
are regarded as a highly modifiable risk factor for cardiovascular disease due to the
influence of cholesterol, one of the most clinically relevant lipid substances, on
atherosclerosis. In addition, some forms may predispose to acute pancreatitis.

Contents
[hide]

• 1 Classification
o 1.1 Hyperlipoproteinemia type I
o 1.2 Hyperlipoproteinemia type II
 1.2.1 Type IIa
 1.2.2 Type IIb
 1.2.3 Treatment
o 1.3 Hyperlipoproteinemia type III
 o 1.4 Hyperlipoproteinemia type IV (type 4 = familial)
o 1.5 Hyperlipoproteinemia type V (type 5 = endogenous)
• 2 Unclassified forms
• 3 References

• 4 External links

Classification
Hyperlipidemias are classified according to the Fredrickson classification which is
based on the pattern of lipoproteins on electrophoresis or ultracentrifugation.[1] It was
later adopted by the World Health Organization (WHO). It does not directly account for
HDL, and it does not distinguish among the different genes that may be partially
responsible for some of these conditions. It remains a popular system of classification,
but is considered dated by many.

Fredrickson classification of Hyperlipidemias

Hyperlipoproteinemi Labs
Synonyms Problems Treatment
a description
Decreased
Buerger-Gruetz
lipoprotein
syndrome, Primary Elevated
lipase
Type I hyperlipoproteinaemia Chylomicron Diet Control
(LPL) or
, or Familial s
altered
hyperchylomicronemia
ApoC2
Polygenic Bile Acid
LDL
hypercholesterolaemia Elevated Sequestrants,
Type IIa receptor
or Familial LDL only Statins,
deficiency
hypercholesterolemia Niacin
Decreased
LDL Elevated
Statins,
Combined receptor LDL and
Type IIb Niacin,
hyperlipidemia and VLDL and
Fibrate
Increased Triglycerides
ApoB
Familial Defect in Drug of
Increased
Type III Dysbetalipoproteinemi ApoE choice:
IDL
a synthesis Fibrate
Type IV Familial Increased Increased Drug of
Hyperlipemia VLDL VLDL choice:
production Fibrate,
 and
Decreased
Niacin
eliminatio
n
Increased
VLDL Increased
Endogenous production VLDL and Niacin,
Type V
Hypertriglyceridemia and Chylomicron Fibrate
Decreased s
LPL

Hyperlipoproteinemia type I

This very rare form (also known as Buerger-Gruetz syndrome, primary

hyperlipoproteinaemia, or familial hyperchylomicronemia) is due to a deficiency of
lipoprotein lipase (LPL) or altered apolipoprotein C2, resulting in elevated chylomicrons,
the particles that transfer fatty acids from the digestive tract to the liver. Lipoprotein
lipase is also responsible for the initial breakdown of endogenously made
triacylglycerides in the form of very low density lipoprotein (VLDL). As such, one would
expect a defect in LPL to also result in elevated VLDL. Its prevalence is 0.1% of the
population.

Hyperlipoproteinemia type II

Hyperlipoproteinemia type II, by far the most common form, is further classified into
type IIa and type IIb, depending mainly on whether there is elevation in the triglyceride
level in addition to LDL cholesterol.

Type IIa

Main article: Familial hypercholesterolemia

This may be sporadic (due to dietary factors), polygenic, or truly familial as a result of a
mutation either in the LDL receptor gene on chromosome 19 (0.2% of the population) or
the ApoB gene (0.2%). The familial form is characterized by tendon xanthoma,
xanthelasma and premature cardiovascular disease. The incidence of this disease is about
1 in 500 for heterozygotes, and 1 in 1,000,000 for homozygotes.

Type IIb

The high VLDL levels are due to overproduction of substrates, including triglycerides,
acetyl CoA, and an increase in B-100 synthesis. They may also be caused by the
decreased clearance of LDL. Prevalence in the population is 10%.
 • Familial combined hyperlipoproteinemia (FCH)
• Secondary combined hyperlipoproteinemia (usually in the context of metabolic
syndrome, for which it is a diagnostic criterion)

Treatment

While dietary modification is the initial approach, many patients require treatment with
statins (HMG-CoA reductase inhibitors) to reduce cardiovascular risk. If the triglyceride
level is markedly raised, fibrates may be preferable due to their beneficial effects.
Combination treatment of statins and fibrates, while highly effective, causes a markedly
increased risk of myopathy and rhabdomyolysis and is therefore only done under close
supervision. Other agents commonly added to statins are ezetimibe, niacin and bile acid
sequestrants. There is some evidence for benefit of plant sterol-containing products and
ω3-fatty acids[2]

Hyperlipoproteinemia type III

This form is due to high chylomicrons and IDL (intermediate density lipoprotein). Also
known as broad beta disease or dysbetalipoproteinemia, the most common cause for this
form is the presence of ApoE E2/E2 genotype. It is due to cholesterol-rich VLDL (β-
VLDL). Prevalence is 0.02% of the population.

Hyperlipoproteinemia type IV (type 4 = familial)

This form is due to high triglycerides. It is also known as hypertriglyceridemia (or pure
hypertriglyceridemia). According to the NCEP-ATPIII definition of high triglycerides
(>200 mg/dl), prevalence is about 16% of adult population.[3]

Hyperlipoproteinemia type V (type 5 = endogenous)

This type is very similar to type I, but with high VLDL in addition to chylomicrons.

It is also associated with glucose intolerance and hyperuricemia

Unclassified forms
Non-classified forms are extremely rare:

• Hypo-alpha lipoproteinemia
• Hypo-beta lipoproteinemia (prevalence 0.01-0.1%)

References
1. ^ Frederickson DS, Lee RS. A system for phenotyping hyperlipidemia.
Circulation 1965;31:321-7. PMID 14262568.
 2. ^ Thompson GR. Management of dyslipidaemia. Heart 2004;90:949-55. PMID
15253984.
3. ^ Third Report of the National Cholesterol Education Program (NCEP) Expert
Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in
Adults (Adult Treatment Panel III) Final Report. Circulation 2002; 106; page
3240

External links
• The Fredrickson papers (with photos from early lipoprotein research)
• 745209914 at GPnotebook

Hyperlipoproteinemia OMIM GPnotebook WebMD Others

Online 'Mendelian
-1389035478 at
Type I Inheritance in Man' . MeritCare
GPnotebook
(OMIM) 238600

Type IIa -1664090094 at

Online 'Mendelian .
GPnotebook
Inheritance in Man' Merck
Type IIb (OMIM) 144400 -1375338454 at
.
GPnotebook

630849560 at
Type III . WebMD Yahoo
GPnotebook

Online 'Mendelian
-1362100182 at
Type IV Inheritance in Man' WebMD Yahoo
GPnotebook
(OMIM) 144600

Online 'Mendelian
-1355481046 at
Type V Inheritance in Man'
GPnotebook
(OMIM) 144600

Definition of Hyperlipidemia
Article updated and reviewed by Hubert Chen, MD, Associate Director of Medical Sciences, Amgen Inc. and
Assistant Professor of Clinical Medicine University of California, San Francisco on May 17, 2005.

Hyperlipidemia is an excess of fatty substances called lipids, largely cholesterol and

triglycerides, in the blood. It is also called hyperlipoproteinemia because these fatty
substances travel in the blood attached to proteins. This is the only way that these
fatty substances can remain dissolved while in circulation.

Hyperlipidemia, in general, can be divided into two subcategories:

 • hypercholesterolemia, in which there is a high level of cholesterol
• hypertriglyceridemia, in which there is a high level of triglycerides, the most
common form of fat

Description of Hyperlipidemia

The fat-protein complexes in the blood are called lipoproteins. The best-known
lipoproteins are LDL (low density lipoprotein) and HDL (high density lipoprotein).

Excess LDL cholesterol contributes to the blockage of arteries, which eventually leads
to heart attack. Population studies have clearly shown that the higher the level of
LDL cholesterol, the greater the risk of heart disease. This is true in men and
women, in different racial and ethnic groups, and in all adult age groups. Hence, LDL
cholesterol has been labeled the “bad” cholesterol.

In contrast, the lower the level of HDL cholesterol, the greater the risk of coronary
heart disease. As a result, HDL cholesterol is commonly referred to as the “good”
cholesterol.

Low HDL cholesterol levels are typically accompanied by an increase in blood

triglyceride levels. Studies have shown that high triglyceride levels are associated
with an increased risk of coronary heart disease.

Text Continues Below

Causes and Risk Factors of Hyperlipidemia

Common secondary causes of hypercholesterolemia (specifically, high LDL

cholesterol) include hypothyroidism (that is, low thyroid hormone levels), pregnancy,
and kidney failure.

Common secondary causes of hypertriglyceridemia include diabetes, excess alcohol

intake, obesity, and certain prescription medications (such as glucocorticoids and
estrogen).

Hyperlipidemia, along with diabetes, hypertension (high blood pressure), positive

family history, and smoking are all major risk factors for coronary heart disease.

Symptoms of Hyperlipidemia
Hyperlipidemia usually has no noticeable symptoms and tends to be discovered
during routine examination or evaluation for atherosclerotic cardiovascular disease.
However, deposits of cholesterol (known as xanthomas) may form under the skin
(especially around the eyes or along the Achilles tendon) in individuals with familial
forms of the disorder or in those with very high levels of cholesterol in the blood.
Individuals with hypertriglyceridemia may develop numerous pimple-like lesions
across their body. Extremely high levels of triglycerides may also result in
pancreatitis, a severe inflammation of the pancreas that may be life-threatening.

Diagnosis of Hyperlipidemia
Diagnosis is typically based on medical history, physical examination, and blood tests
(done after overnight fasting) in order to determine the specific levels of LDL
cholesterol, HDL cholesterol, and triglycerides.

Treatment of Hyperlipidemia
It is necessary to first identify and treat any potential underlying medical problems,
such as diabetes or hypothyroidism, that may contribute to hyperlipidemia.
Treatment of hyperlipidemia itself includes dietary changes, weight reduction and
exercise. If lifestyle modifications cannot bring about optimal lipid levels, then
medications may be necessary.

Current national guidelines suggest a LDL cholesterol goal of <100 mg/dl for
individuals already with heart disease or diabetes, <130 mg/dl for those with
moderate risk of heart disease, and <160 mg/dl for everyone else. Your doctor can
calculate your “risk score” for heart disease. This score can then be used to
determine whether you need to start taking medications to lower your LDL
cholesterol.

Although there are no firm treatment targets for HDL cholesterol or triglycerides,
most experts agree that optimal HDL cholesterol and triglyceride levels are >40
mg/dl and <200 mg/dl, respectively.

Medications most commonly used to treat high LDL cholesterol levels are statins,
such as atorvastatin (Lipitor) or simvastatin (Mevacor). These medications work by
reducing the production of cholesterol within the body. Although safe and effective,
statins very rarely cause muscle damage, typically when used in combination with
other medications. Thus, it is important to let your doctor know whether you develop
any generalized body ache or start a new medication when you are taking statins.

Other medications used to treat high LDL cholesterol levels include ezetimibe (Zetia),
which decreases the absorption of cholesterol from the gut; bile-acid sequestrants
(Questran), which eliminate cholesterol from the body; and nicotinic acid (Niacin),
which, in addition to lowering LDL cholesterol, raises HDL cholesterol.

Hypertriglyceridemia is typically treated with a class of medications called fibrates.

Included in this class are gemfibrozil (Lopid) and fenofibrate (Tricor). Similar to
statins, fibrates are safe and effective but may cause muscle damage, usually when
used in combination with other medications.