dislipidemias

Dyslipidemias are disorders of lipid metabolism characterized by abnormal levels of lipids in the blood, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. They can be inherited (primary) or acquired (secondary) and are a major risk factor for atherosclerotic cardiovascular disease, pancreatitis in severe hypertriglyceridemia, and other metabolic complications.

Primary (genetic) dyslipidemias include conditions such as familial hypercholesterolemia, which elevates LDL-C and increases premature cardiovascular risk; familial combined hyperlipidemia, which causes elevations in multiple lipid fractions; familial hypertriglyceridemia; and familial hypoalphalipoproteinemia, characterized by low HDL-C. Secondary dyslipidemias arise from obesity, type 2 diabetes, hypothyroidism, chronic kidney or liver disease, nephrotic syndrome, and certain medications (for example, steroids, retinoids, thiazide diuretics, protease inhibitors).

Diagnosis relies on a fasting lipid panel to assess LDL-C, HDL-C, and triglycerides, with additional testing (such as lipoprotein(a) levels or genetic testing) in selected cases. Classification is based on the pattern of lipid abnormalities: elevated LDL-C, elevated triglycerides, low HDL-C, or mixed dyslipidemia. Management emphasizes cardiovascular risk reduction through lifestyle measures (weight management, physical activity, dietary changes limiting saturated and trans fats, and increased soluble fiber) and pharmacotherapy. First-line pharmacotherapy typically includes statins; other options include ezetimibe, PCSK9 inhibitors, and bempedoic acid. For hypertriglyceridemia, fibrates or high-dose omega-3 fatty acids may be used, with caution regarding combination therapy.

Screening and treatment targets are guided by cardiovascular risk assessment and current guidelines, which may vary by region.