Dyslipidemia

Happy Monday, and welcome to Medical Mondays! While we’re still in American Heart Month, I figured I’d use my last Monday in February to talk about dyslipidemia! Also known as high levels of fat in your blood, which is most commonly correlated with high cholesterol.

Why do we care so much about cholesterol anyway, and is it really that bad?

Dyslipidemia/Hypercholesterolemia is when you have an excess of low-density lipoproteins (LDL) or insufficient high-density lipoproteins (HDL).

LDL is the most important lipid parameter for atherosclerotic cardiovascular disease risk assessment.

It’s reported to be a measurement based on the formula (so if you ever get a couple of your lab results back from your physician and feel like calculating away, try this out!):

| LDL | = | Total cholesterol | – | HDL | – (| triglycerides | / 5 )

Over time, chronically elevated cholesterol in the blood can lead to the formation of plaques in the arteries, which in turn can lead to stenosis (narrowing) or complete occlusion (blockage) of the arteries. In addition, smaller plaques can rupture and cause clots to form, which will also obstruct blood flow.

The occlusion of a coronary artery results in a myocardial infarction (heart attack), and the occlusion of an artery that supplies the brain can cause a stroke. Stenosis or occlusion of blood supply to an organ can result in impaired organ function due to reduced blood flow.

Risk Factors

Although there are a number of factors, including a significant genetic component, that play into hypercholesterolemia, there are several that contribute to a higher LDL + lower HDL:

• Obesity
• Diabetes Mellitus
• Tobacco Use
• Alcohol abuse
• Diets high in fatty foods
• Increased estrogen exposure (including oral contraceptive pills)
• Certain medications (e.g. diuretics, cyclosporine, glucocorticoids, amiodarone)

• Xanthelasmas (lipid deposits around the eyelids)
• Xanthomas (lipid deposits on the trunk)
• Retinal cholesterol emboli

Individuals with extremely elevated triglyceride levels are at risk for pancreatitis.

Screening

Although there’s currently no consensus on when regular lipid testing should be implemented in higher-risk individuals, screening typically begins at:

• 20-25 years of age for high-risk men
• 20-35 years of age for high-risk women

Treatment

Lifestyle Modification

I’m sure I’m starting to sound very much like a broken record, but it honestly boils down to the following:

• Diet (decreasing dietary fat intake)
• Exercise programs have been shown to raise your HDL!
• Weight Reduction
• Smoking Cessation

(All of these help to reduce your risk of heart disease!)

Medications

Statins are considered first-line for treating dyslipidemia if dietary modifications are ineffective. They are especially beneficial in treating patients with:

1. LDL > 190
2. Clinical ASCVD (previous MI, coronary artery disease, cerebrovascular attack, peripheral artery disease)
3. Diabetes mellitus

• Fish oil has also been shown to decrease triglyceride levels!

Disclaimer: The information in this post was gleaned from UpToDate articles and other med school resources. This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)