Hyperlipidaemia

Hyperlipidaemia is a condition characterized by elevated levels of lipids in the blood, most often cholesterol and triglycerides. It is a major risk factor for atherosclerotic cardiovascular disease. Lipids are carried by lipoproteins, mainly LDL, HDL and VLDL. The common abnormalities are high LDL-C, low HDL-C, and high triglycerides.

Causes are broadly categorized as primary (genetic) and secondary (acquired). Primary disorders include familial hypercholesterolemia and other inherited hyperlipidaemias. Secondary causes include obesity, diabetes, hypothyroidism, nephrotic syndrome, liver disease, alcoholism, and certain medications.

Diagnosis uses a lipid panel to measure LDL-C, HDL-C, total cholesterol and triglycerides. Fasting values were traditionally preferred, but nonfasting testing is increasingly used. Assessment of cardiovascular risk guides treatment; very high LDL-C or triglycerides may prompt genetic evaluation for familial disorders.

Management combines lifestyle modification and pharmacotherapy. Lifestyle measures include weight management, a diet rich in fruits, vegetables and fiber, physical activity, and avoiding tobacco. First-line pharmacotherapy is statins; alternatives or add-ons include ezetimibe, PCSK9 inhibitors, bempedoic acid, and fibrates for severe hypertriglyceridaemia.

Prognosis improves with treatment, reducing cardiovascular events. Prevalence rises with age and varies by population. Screening recommendations differ, but lipid testing is commonly advised every five years in adults, with more frequent testing for those with risk factors or a known lipid disorder.