hyperlipidemias

Hyperlipidemias are a group of disorders characterized by elevated levels of lipids in the blood, most commonly cholesterol and triglycerides. These abnormalities can contribute to accelerated atherosclerosis and increase the risk of cardiovascular disease, including heart attack and stroke. Lipid disorders may be present from birth or develop later in life and often coexist with metabolic risk factors such as obesity, diabetes, and hypertension.

Classification typically divides hyperlipidemias into primary (genetic) and secondary (acquired or lifestyle-related) forms. Primary disorders include familial hypercholesterolemia, caused by mutations affecting LDL receptor function or apolipoprotein B or PCSK9, and familial combined hyperlipidemia, among others. Secondary causes include diabetes mellitus, hypothyroidism, nephrotic syndrome, liver disease, obesity, excessive alcohol intake, and certain medications. Lipids are usually assessed with a fasting lipid panel measuring LDL-C, HDL-C, and triglycerides; thresholds vary by age and guidelines, with unusually high LDL-C or triglycerides indicating a need for further evaluation. Genetic testing and clinical scoring systems (for example, the Dutch Lipid Clinic Network criteria or Simon Broome criteria) may aid in diagnosing familial forms.

Management focuses on reducing cardiovascular risk through lifestyle changes and pharmacotherapy. Lifestyle measures include a healthy diet, weight management, regular physical activity, and avoiding tobacco. First-line pharmacotherapy is usually statins to lower LDL-C, with ezetimibe or PCSK9 inhibitors as add-on therapies for certain high-risk patients. Fibrates or omega-3 fatty acids may be used to address severe hypertriglyceridemia. Regular follow-up includes lipid monitoring, assessment of tolerance, and screening of first-degree relatives when a hereditary disorder is identified.