Hyperlipidemia

Hyperlipidemia refers to the abnormal accumulation of lipids in the blood. It is of concern because of its influence on the development of atherosclerosis, which is the formation of arterial fibrofatty plaques. Hyperlipidemia affects millions of people worldwide. According to WHO data, the global prevalence of hyperlipidemia in the world is estimated to be 39%.

Hyperlipidemia is divided into primary and secondary causes. Primary causes are often genetic and occur because of underlying dysfunction in lipid metabolism. Secondary causes include diabetes, hypothyroidism, nephrotic syndrome and alcohol consumption. Uncontrolled hyperlipidemia can lead to the development of atherosclerosis. In atherosclerosis, retained low density lipoproteins (LDLs) in the vessel walls produce an inflammatory response that attracts monocytes to penetrate and cluster within the vessel wall. In what is often a decades long process, these plaques accumulate in size. The size of their accumulation can severely reduce blood flow to vital end organs, such as the heart and brain. In addition, the plaque can rupture and produce emboli that similarly block arteries and reduce blood supply to vital end organs.

Hyperlipidemia and atherosclerosis are otherwise silent processes that only become known clinically when atherosclerotic plaques rupture or when their size produces critical stenosis. If it reaches this point, patients may present complaining of chest pain, palpitations, dizziness, slurred speech, visual changes and focal weakness.

In asymptomatic patients, a lipid panel may be sent to assess the degree of hyperlipidemia. This test is typically performed by the patient’s primary care physician. Lipid panels should be checked routinely by a primary care physician to evaluate for hyperlipidemia in asymptomatic patients.

1. Asymptomatic hyperlipidemia and atherosclerosis are managed with statin therapy and lifestyle adjustments.

2. Symptomatic hyperlipidemia/atherosclerosis presenting with signs of acute myocardial infarction or stroke will be managed accordingly. Some patients may need catheterizations and stent placements as definitive therapy for stenotic vessels.