Dyslipidemia: Your Comprehensive Guide to Understanding and Managing

3. Signs, Causes, and Symptoms of Dyslipidemia

5. Diagnosis, Treatment, and Medications for Dyslipidemia

Dyslipidemia, an abnormality in blood lipid levels, impacts individuals worldwide, posing a significant risk for various health conditions. The World Health Organization (WHO) estimates that approximately 2 billion people globally have elevated cholesterol or lipid levels. Incidence rates of dyslipidemia vary across nations and populations, influenced by factors such as age, gender, ethnicity, and lifestyle choices including diet and physical activity.

What is dyslipidemia?

Dyslipidemia is the imbalance of lipids such as triglycerides, high density lipoproteins (HDL), low-density lipoprotein cholesterol (LDL), and cholesterol. This condition is caused due to fatty diet, exposure to tobacco or inheritance and can result in severe cardiac complications. Generally, in dyslipidemia conditions LDL and triglycerides are too high whereas HDL (good cholesterol) will be low. The “bad” type of cholesterol is referred to as LDL cholesterol. This is due to the fact that it may accumulate and create plaque or clumps in the artery walls. As HDL aids in the removal of LDL from your blood, it is considered the “good” cholesterol. Calories that you ingest but do not immediately burn off are converted into triglycerides.

Types of dyslipidemia

Dyslipidemia is categorized based on its etiology into two types: inherited and lifestyle-induced. The appropriate treatment approach depends on the type of dyslipidemia you have.

Primary dyslipidemia: The primary dyslipidemia is caused by inheritance. Some specific types of primary dyslipidemia include: familial combined hyperlipidemia (this might result in elevated cholesterol and occurs in teenagers and young adults); familial hypobetalipoproteinemia (this is caused by a mutation in the apolipoproteins, which is a class of LDL lipoproteins); familial hypertriglyceridemia (this causes levels of triglycerides to rise); and homozygous familial or polygenic hypercholesterolemia (this is due to a mutation in LDL receptors).
Secondary dyslipidemia: Secondary dyslipidemia is mainly caused by the interference of lifestyle factors and some medical conditions with lipid levels in the body.

Signs, Causes, and Symptoms of Dyslipidemia

Dyslipidemia signs and symptoms : It’s possible that one may have dyslipidemia without noticing it. Similar to high blood pressure, excessive cholesterol doesn’t always have symptoms. In many cases, a standard blood test or lipid profile test will reveal it. Generally, dyslipidemia symptoms are not noticeable, as it often has no symptoms.

Some of the signs of dyslipidemia include:

Skin xanthomas: These are yellowish lumps that can develop on your skin; they are particularly common around your knees, buttocks, and elbows. Cholesterol deposits lead to this condition.
Arcus cornealis: This is a ring of white surrounding the colored portion of the eye which could indicate elevated cholesterol.

As dyslipidemia is symptomless, the complications due to it, such as peripheral artery disease and coronary artery disease, show symptoms.

Dyslipidemia causes : Dyslipidemia is a condition that is not only caused by a single factor but also influenced by a number of lifestyle and genetic factors. The main reasons for dyslipidemia include the following:

Exposure to tobacco or nicotine: The endothelium, the lining that lines the arteries, can be directly damaged due to the compounds found in cigarettes. Smoking raises the body’s concentrations of free radicals, which are harmful chemicals that harm cells and cause inflammation.
Overweight:Overweight individuals tend to accumulate excess fat, particularly visceral fat in the abdomen, leading to increased release of free fatty acids into the bloodstream from this tissue.
Sedentary lifestyle: Dyslipidemia risk is significantly increased by a sedentary lifestyle, which is characterized by low levels of physical activity and modern lifestyle.
Autosomal dominant mutations due to familial or genetic inheritance: Single and multiple gene mutations result in dyslipidemia.
Medical conditions like metabolic disorders: Metabolic disorders such as diabetes, thyroid abnormalities, Cushing syndrome, and polycystic ovarian syndrome lead to fat abnormalities, which in turn increase the risk of developing dyslipidemia.
Nutrition abnormalities: Vitamin deficiencies and malabsorption syndromes increase the risk of dyslipidemia.
Cushing syndrome: Cushing syndrome, which is characterized by an elevated level of the stress hormone cortisol, can cause altered liver metabolism, decreased production of HDL (“good”) cholesterol, increased lipolysis, and free fatty acid release, resulting in dyslipidemia.
Consumption of fatty foods and more: Low intake of unsaturated fats, excess intake of trans fats and saturated fats, contribute to dyslipidemia.

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Dyslipidemia complications

There is no rule that says everyone might get complications from dyslipidemia. However, there are some possible complications from dyslipidemia in some patients. If left untreated, such as

Cardiovascular diseases: Blockage due to plaque formation and narrowing of the arteries due to excess cholesterol might lead to cardiovascular diseases such as heart attack, stroke, atherosclerosis, or peripheral artery disease (PAD).
Pancreatitis: High triglyceride levels might result in inflammation of the pancreas.
Fatty liver disease: Excess fat buildup in the liver results in fatty liver disease.

Diagnosis, Treatment, and Medications for Dyslipidemia

Dyslipidemia diagnosis : Dyslipidemia is diagnosed through laboratory testing, physical examinations, and clinical evaluations. Doctors interpret test findings based on age- and gender-specific reference ranges to confirm the diagnosis and determine the specific type of dyslipidemia.:

Preliminary evaluation: Doctors initially assess the patient’s overall health condition, medical and medication history, and family history, followed by the recommended tests.
Lipid profile tests: Followed by the assessment of the patient, triglycerides, high-density lipoproteins (HDL), and low-density lipoprotein cholesterol (LDL) will be measured as suggested by the doctor. The patient needs to fast for 9–12 hours prior to the test.
ApoB, or lipoprotein (a): This test is suggested additionally in some cases in order to get a complete picture of the lipids in the body.

Dyslipidemia treatment : The main treatment goal for dyslipidemia is to reduce the elevated lipid levels to normal levels and minimize the risk of further complications. Treatment for dyslipidemia includes lifestyle modifications and medication therapy.

Lifestyle modifications

Less trans fat and more fruits, vegetables, and healthy fats should be included in the diet
Avoid highly refined sugar and cholesterol foods
40 minutes of physical activity should be performed at least five times a week
A healthy weight should be maintained
Cutting off alcohol and smoking needs to be done.
Regular lipid profile checkups should be done

Dyslipidemia medications : There are some classes of medications specifically used to treat dyslipidemia, such as:

Statin therapy: Statins such as (HMG-CoA) reductase inhibitors, are primarily suggested to the dyslipidemic patients in order to lower the bad cholesterol levels in the body.
Ezetimibe: This class of drugs are additionally given with statins in order to lower LDL by reducing the intestinal absorption of cholesterol.
PCSK9 inhibitors: Suggested for people who are intolerant to statins or have extremely high LDL levels.
Fibrates: These medications marginally increase HDL and lower triglycerides.
Supplements containing omega-3 fatty acids: These medications help those with elevated triglycerides.
Bile acid sequestrants: Bind bile acids within the intestine to inhibit the absorption of cholesterol.

Dyslipidemia vs hyperlipidemia

High blood cholesterol is referred to as hyperlipidemia. On the other hand, dyslipidemia indicates an abnormal level or imbalance between good to bad cholesterol which isn’t above the normal limits. If you have either hyperlipidemia or dyslipidemia, your risk of cardiovascular disease could increase.