What Is Hyperlipidemia?

Medically Reviewed by Zilpah Sheikh, MD on March 04, 2024
Written by Paige Fowler, Shawna Seed
10 min read

You call it high cholesterol. Your doctor calls it hyperlipidemia, or dyslipidemia. No matter what name you use, it's a common problem.

The term covers several disorders that result in extra fats, also known as lipids, in your blood. You can control some of its causes, but not all of them.

Types of lipids

Your body contains several kinds of lipids. The main types you've heard of are probably HDL cholesterol and LDL cholesterol, also known as "good" and "bad" cholesterol.

HDL stands for "high-density lipoprotein." This type carries cholesterol through your blood to your liver, where it's used to build cells and make hormones, among other things. Your liver gets rid of cholesterol that's not used. If you don't have enough HDL, cholesterol builds up in your blood instead of being carried away by your liver.

LDL stands for "low-density lipoprotein," the type known as "bad" cholesterol. It causes buildup in your arteries. Too much of it can lead to heart disease.

Triglycerides are another type of lipid. This is the most common type of fat in your body. They mostly come from foods you eat that are high in fat. 

Another type is very low-density lipoprotein, or VLDL. It's considered a "bad" cholesterol because too much raises your risk of heart disease..

It's estimated that 93 million adults in the U.S. have high cholesterol.

Hyperlipidemia is treatable, but it's often a lifelong condition. You'll need to watch what you eat and also exercise regularly. You might need to take a prescription medication, too.

The goal is to lower harmful cholesterol levels. Doing so can reduce your risk of heart disease, heart attack, stroke, and other problems.

If you have hyperlipidemia, you have high lipid levels – including triglycerides and LDL – in your blood.

Another type of cholesterol problem is called hypercholesterolemia. That means only your LDL levels are too high. 

Hyperlipidemia has many causes. Some are related to lifestyle, and some are the result of medical issues. 

Diet 

Cholesterol, a waxy substance, is a type of fat your body makes. It can also come from what you eat.

Foods that have cholesterol, saturated fat, and trans fats can raise your blood cholesterol level. These include:

  • Cheese
  • Egg yolks
  • Fried and processed foods
  • Ice cream
  • Pastries
  • Red meat

Lifestyle 

Your habits also can play a role in hyperlipidemia. You're at higher risk if you: 

  • Smoke
  • Drink too much alcohol
  • Are overweight
  • Don't get enough exercise
  • Are stressed

Medical conditions

Some health issues affect your cholesterol levels. They include:

  • Diabetes
  • Liver disease 
  • Problems with your pancreas
  • Multiple myeloma
  • Polycystic ovary syndrome (PCOS)
  • Hypothyroidism
  • Lupus
  • Kidney disease 
  • Sleep apnea
  • HIV
  • Primary biliary cholangitis, a problem with your gallbladder 

Medications

Medicines that you take for other conditions also can affect your cholesterol levels. Those include: 

  • Steroids
  • Beta-blockers
  • Diuretics
  • Hormonal birth control
  • Antiretrovirals for HIV

Hyperlipidemia can run in families. People who inherit the condition can get very high cholesterol. They have a much greater chance of having a heart attack, even when they're young. 

What is mixed hyperlipidemia?

When you have this, you have high triglycerides and LDL, as well as low HDL. It's an inherited condition, part of a group called "familial hyperlipidemia." It's the most common type found among young people who have had heart attacks. 

Familial hypercholesterolemia is a genetic condition that causes high LDL only. Another inherited condition that affects your cholesterol is familial hypertriglyceridemia. When you have this, your body produces too much VLDL. As a result, your VLDL and triglyceride levels will be high.

Most people with hyperlipidemia can't tell that they have it at first. A blood test is the only way to find out if you have it. It's not something you can feel, but you may notice the effects of it someday.

Cholesterol, along with triglycerides and other fats, can build up inside your arteries. This makes the blood vessels narrower and makes it more difficult for blood to get through. Your blood pressure could go up. The narrowing of your arteries could cause several problems: 

Coronary artery disease

CAD is the most common form of heart disease in the U.S. When your arteries get clogged, it becomes harder for your heart to get the blood it needs to work correctly. That can lead to a heart attack or heart failure. You may not realize it's happening until you have chest pain (also called angina) or some other symptoms of a heart attack.

Heart attack

The stuff clogging up your arteries (called plaques) can break off, creating a blood clot. The clot might block the flow of blood in your artery right there, or it might break free and travel down an artery, creating a blockage farther along. If the blockage causes part of your heart to stop getting blood flow, you're having a heart attack. Symptoms of a heart attack include: 

  • Chest pain
  • Pain that spreads to your jaw, shoulder, arm, back, or neck
  • Cold sweat
  • Indigestion or nausea
  • Shortness of breath
  • Dizziness
  • Fatigue
  • Women may have a sharp pain in the back, neck, or arm.

Stroke

When you have a stroke, a clot travels through your body and blocks blood flow to part of your brain. Symptoms of a stroke include: 

  • Headache that comes on suddenly and is severe
  • Trouble speaking – slurred words, or not being able to speak. You might also have trouble understanding what people are saying. 
  • Numbness or weakness. This may affect just one side of your body. One side of your mouth may droop when you try to smile. 
  • Vision problems. You eyesight might be blurred in one or both eyes. 
  • Balance issues. You might have trouble walking. 

Fatty growths

If you have inherited hyperlipidemia, you might see yellow, fatty deposits under your skin. These are places where cholesterol has built up. If they're around your eyelids next to your nose, they're called xanthelasmas.

These deposits also can show up other places on your body, and when they do, they're called xanthomas. The most common places to get them are your elbows, knees, other joints, hands, feet, and butt.

To diagnose hyperlipidemia, your health care provider will order a test that checks the levels of cholesterol and triglycerides in your blood. Names for this test include lipid panel, lipid test, lipoprotein panel, and lipid profile.

Your doctor should check your lipid levels regularly. 

Lipid panel

The results of this test show the levels of:

LDL cholesterol: The "bad" cholesterol that builds up inside your arteries

HDL cholesterol: The "good" cholesterol that lowers your risk for heart disease

Triglycerides: Another type of fat in your blood

Total cholesterol: A combination of the other three numbers

The American Heart Association recommends that adults 20 and older have their cholesterol checked every 4 to 6 years. You may have to fast 9 to 12 hours before the test.

Total cholesterol of 200 milligrams per deciliter (mg/dL) or more is out of the normal range. Your doctor will consider things like your age, whether you smoke, and whether a close family member has heart problems to decide whether your specific test numbers are high and what to do about them. Each measurement is broken down further into categories. For total cholesterol, the numbers used in the U.S. are: 

  • Below 200 mg/dL is the goal
  • 200-239 mg/dL is borderline high 
  • 240 or more is high

For HDL cholesterol: 

  • Below 40 mg/dL for men and 50 mg/dL for women is poor
  • 40-59 mg/dL (men) and 50-59 mg/dL (women) is better 
  • Above 60 mg/dL is best 

For LDL cholesterol, the goals change a bit based on your health and risk factors: 

  • Below 70 mg/dL if you have a history of heart disease 
  • Below 100 mg/dl if you're at risk of heart disease or have diabetes
  • 100-129 mg/dL is acceptable if you have no coronary artery disease. If you do have CAD, this is high. 
  • 130-159 mg/dL is borderline if you don't have CAD, high if you do.
  • 160-189 mg/dL is high if you don't have CAD, very high if you do. 
  • Above 190 mg/dL is very high and probably means you have a genetic condition. 

Triglyceride guidelines: 

  • Below 150 mg/dL is the goal. 
  • 150-199 mg/dL is borderline high. 
  • 200-499 mg/dL is high. 
  • Above 500 is very high.

 

Hyperlipidemia self-care

Lifestyle changes that can lower your cholesterol include a healthy diet, weight loss, and exercise. You should:

  • Choose foods low in trans fats and saturated fats. One way to do this is to substitute oils such as olive, sunflower, safflower, and canola for other fats in cooking.
  • Eat more fiber-rich foods, such as oatmeal, apples, bananas, pears, prunes, kidney beans, chickpeas, lentils, and lima beans. Soluble fiber reduces your LDL cholesterol.
  • Have fish twice a week. Fatty fish (tuna, salmon, mackerel, herring, trout) contains omega-3 fatty acids, which lower your triglycerides. You also can get omega-3 from walnuts, flaxseed, and canola oil.
  • Avoid sugary drinks and added sugars.
  • Avoid fried and processed meats.
  • If you smoke, quit. When you stop smoking, your HDL (good cholesterol) levels go up. Experts say to quit smoking, you should focus on your motivation for quitting, get support, maintain your confidence level, and learn from past attempts. You can talk to your doctor about medications that can help. 
  • Sleep at least 7 hours each night. Poor sleep has been linked to high blood pressure and heart disease.
  • Manage your stress level. High stress is linked to inflammation in your body, which can raise your blood pressure and lower your HDL levels. Ways to reduce stress include meditation, journaling, yoga, exercise, and counseling.
  • Limit your alcohol, too. That means no more than one drink a day.
  • Step up your exercise habits. Aim for about 30 minutes of moderate-intensity activity, like a brisk walk, most days of the week. You don't have to do it all at once. Even 10 to 15 minutes at a time can make a difference.

For some people, diet and lifestyle changes may be enough to bring their cholesterol levels into a healthy range. Other people may need more help.

Statins: Drugs that prevent your liver from making cholesterol are known as statins. They're a popular choice to lower the amount of cholesterol in your blood. But in some people, statins cause serious side effects, including muscle pain, mental confusion, and digestion problems. In rare cases, they can cause liver damage. Talk to your doctor about weighing the benefits versus the side effects, if you have any. Don't just stop your medication.

Cholesterol absorption inhibitors: These are a newer type of drug that blocks cholesterol that you've eaten from being taken into your body by your intestine. They work in combination with statins. An example is the drug ezetimibe (Zetia). 

PCSK9 inhibitors: These are also a new class of drugs. They lower LDL, or “bad,” cholesterol. PCSK9 is a protein in your liver that can increase your cholesterol level. These drugs work by blocking the receptors of the protein, which allows your liver to clear away more cholesterol. Right now, there are two FDA-approved medications: alirocumab (Praluent) and evolocumab (Repatha). Studies show that PCSK9 inhibitors can actually prevent heart attacks or strokes. 

Bempedoic acid: This drug (Nexletol) works in your body much the same way statins do, but it's less likely to cause muscle pain. There's also a combination (Nexlizet) of it and ezetimibe available.

Nicotinic acid: This also affects how your liver makes fats. It lowers your LDL cholesterol and triglycerides and raises your HDL cholesterol. 

Bile-acid binding resins: These medications trick your body into using up cholesterol. They bind to bile, an acid involved in digestion, so it can't do its job. Your liver has to make more bile, and for that, it needs cholesterol. That leaves less cholesterol in your bloodstream. 

Fibrates: The drugs fenofibrate (Tricor, Fenoglide) and gemfibrozil (Lopid) lower the amount of very low density cholesterol (VLDL) your body makes and helps your body remove triglycerides from your blood. If you take it with a statin, that increases the risk of statin side effects. 

Niacin: This drug limits how much LDL and VLDL your liver can make. It's been linked to liver damage and strokes, so your doctor isn't likely to prescribe it unless you can't take statins.

Omega-3 supplements: Your doctor can prescribe these, or you can buy them over the counter. They can help lower triglycerides. But check with your doctor before you start taking them; they might interact with other medicines.

Other supplements: Many supplements are touted as good for treating high cholesterol. They include berberine, flaxseed, garlic, green tea, red yeast rice, C 15:0, and nattokinase. The evidence that these supplements work varies. If you want to try one, talk to your doctor about it first. 

Because hyperlipidemia affects so many people. researchers continue to look for new ways to treat it. One new drug, called inclisiran, works by interfering with your body's production of PCSK9, rather than just blocking reception of it. 

If your doctor prescribes a drug to control your cholesterol, you'll likely have to take it long-term to keep your levels in check.

When you have hyperlipidemia, you have high levels of fats (lipids) in your blood. More commonly, it's called high cholesterol. It has many causes, including genetics, what you eat, and how active you are. You can alter your diet and make other lifestyle changes to bring your cholesterol down, but you may also need medication. Untreated, hyperlipidemia can lead to coronary artery disease, a leading cause of heart attacks and strokes. 

What foods are good if you have hyperlipidemia?

Fatty types of fish – mackerel, salmon, herring, tuna, and trout – contain omega-3 fatty acids, which can reduce your triglyceride levels. Walnuts, flaxseed, and canola oil also have omega-3 fatty acids. High-fiber foods reduce your levels of LDL, or "bad" cholesterol. Smart choices include oatmeal, oat bran, apples, pears, and Brussels sprouts. You can buy margarine and orange juice with added plant sterols and stanols, substances that help keep your body from absorbing cholesterol. Avocados are high in monounsaturated fatty acids and contain fiber. Guacamole isn't an especially healthy choice, but plain sliced avocados can lower your cholesterol.

How do you treat hyperlipidemia in adults?

Start with lifestyle changes – eat a healthier diet, get more exercise, limit your alcohol intake, get 7 hours a sleep each night, and don't smoke. If lifestyle changes aren't enough to bring your cholesterol numbers into a healthy range, your doctor may prescribe medicine to help treat your hyperlipidemia.