Learn to manage hyperlipidemia to lower your risk of heart disease and stroke

Authors: Dr. Amy Zhao (Pharm.D), Wendy Chen (Pharm. D. Candidate)

What is Hyperlipidemia?

Lipids (or fats) are naturally found in blood. The term hyperlipidemia means that the lipid levels in the blood are too high. In general, lipids can be divided into two types: cholesterol and triglycerides. High-density lipoprotein (HDL) and low-density lipoprotein (LDL) are two types of cholesterol. LDL is known as “bad cholesterol” and high levels of LDL can increase your risk of heart disease and stroke. However, not all types of cholesterol are bad: HDL is known as “good cholesterol”. HDL helps to remove LDL from your body and having high levels of HDL can help decrease your risk of heart disease and stroke. Triglycerides are another type of lipid found in your blood and high levels of triglycerides can also increase the risk of heart disease and stroke.

Consequences of Hyperlipidemia

Hyperlipidemia can lead to serious health problems. LDL cholesterol can deposit and accumulate in the walls of arteries. This can lead to the formation of plaques that can reduce blood flow. This condition, also called atherosclerosis, can cause blood vessel diseases such as coronary heart disease and peripheral artery disease (PAD). It can also lead to heart attack and stroke. Coronary heart disease and PAD are caused by atherosclerosis and the narrowing of arteries, while heart attack and stroke are caused by blood clots which form when a plaque bursts.

What causes hyperlipidemia?

Many factors can contribute to high LDL cholesterol and triglycerides. For example, obesity, poorly controlled diabetes, underactive thyroid and kidney disease can all lead to high levels of triglycerides. An unhealthy diet, smoking and lack of exercise can all contribute to hyperlipidemia. Genetics can also play a role in high LDL levels. People who have a condition called familial hypercholesterolemia (FH) are born with high LDL levels. FH is caused by a mutation that makes it difficult for the body to remove LDL from the blood.

Symptoms & Lipid Level Screening

Most people do not experience any symptoms of hyperlipidemia until it is very severe. At this stage, the high amounts of cholesterol deposited in the arteries can lead to chest pain, heart attack or stroke. In addition, when hyperlipidemia has progressed, it can also cause:

- Abdominal pain

- Pancreatitis

- Yellow lipid deposits under the skin

- Lipid deposits in the eyes resulting in a white or grey ring

- Damage to nerves resulting in burning or tingling pain

The only way to detect hyperlipidemia early on is through a blood test. Routine blood tests to check lipid levels generally start for men when they are 40 years old and for women when they are 40 years old (or when they have reached menopause). If you have certain medical conditions or a family history of early heart disease, your lipid levels may be checked at an earlier age. Some of these medical conditions include:

- Obesity

- Diabetes

- Chronic kidney disease

- Current cigarette smoking

- Chronic obstructive pulmonary disease

- Any condition that occurs as a result of lipid accumulation in the arteries (this includes chest pain, heart attack, stroke and muscle cramping in the lower legs due to poor blood circulation)

How to Manage Hyperlipidemia

You can lower your chance of heart disease, heart attack and stroke by managing hyperlipidemia. Depending on your lipid levels and the presence of any other medical conditions, you may be given a 3-month trial of dietary and other lifestyle changes to lower your lipids levels before starting medications.

Diet & Other Lifestyle Changes:

In general, cholesterol comes from animal-based foods like meat and dairy products. Cholesterol is not found in plant-based foods like fruits, vegetables and grains. Limiting your meat intake and increasing your fruits and vegetable intake can help lower your lipid levels. Instead of meat, consider increasing fish intake: omega-3 found in fish can help lower triglycerides. Plant sterols found in vegetable oils (for example, olive oil), nuts, fruits, vegetables and whole grains can help lower LDL. Fruits and vegetables are also good sources of fiber which also help lower LDL. Other high fiber foods to add to your diet include oatmeal and beans.

A sedentary lifestyle can also increase your risk of heart disease. Aiming for 150 minutes of physical activity (such as walking, swimming and cycling) a week can help lower lipid levels and help you maintain a healthy weight. One hundred and fifty minutes per week may sound like a lot, but it is only about 20 minutes a day!

Smoking cessation is another important step towards controlling lipid levels. Smoking on its own is a risk factor for heart disease. Smoking cessation can help raise HDL and lower LDL.

Lipid-Lowering Medications:

Sometimes diet and lifestyle changes are not enough to lower lipid levels and medications are required. This is especially true if you have a history of heart disease or stroke. There are many types of medications that work differently to help control lipid levels. Some people may require more than one lipid-lowering medication. For many people, these medications are taken long-term to help lower the future risk of heart disease, heart attack and stroke.

Statins (atorvastatin, rosuvastatin, simvastatin, pravastatin, lovastatin, fluvastatin)

Some amount of cholesterol is needed for our bodies to function. Our liver naturally makes cholesterol. Statin medications help lower the amount of LDL our liver makes. Statins are the most commonly used lipid-lowering medications: they are usually the first medications that are tried because they are very effective at lowering LDL.

Ezetimibe

Ezetimibe is a medication that prevents our bodies from absorbing cholesterol from our food. Sometimes it is added to statin therapy to further lower LDL. Ezetimibe may be taken by itself in people that experience side effects (such as muscle pain) from statins.

Fibrates (fenofibrate, bezafibrate, gemfibrozil)

Unlike statins and ezetimibe which are mainly used to lower LDL, fibrates are mainly used to lower triglycerides and raise HDL.

Resins/ Bile Acid Sequestrants (cholestyramine, colesevelam, colestipol)

These medications prevent our bodies from recycling bile. This forces our bodies to use LDL to make more bile. By using up the LDL, the LDL levels in the blood decrease.

Niacin

Niacin is also known as vitamin B3. It can help reduce the amount of LDL our bodies produce. Niacin is also used to increase HDL.

Vascepa

Vascepa contains EPA, a type of omega-3 fatty acid found in fish oil. Vascepa is used in people that are already taking statins to help lower triglycerides.

PCSK9 Inhibitors (evolocumab, alirocumab)

When other medications fail to lower the cholesterol levels to the target, PCSK9 inhibitors are added on to further lower LDL levels. These medications are different from the other medications (which are taken by mouth) in that they are injected every 2 weeks or monthly.

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These presentations are intended for general information purposes only. Audience are recommended to consult with qualified healthcare provider and obtain professional advice and subsequent management for your particular conditions. The views and opinions expressed by the speakers do not necessarily reflect the policy or position of Assisting in Medical Expectations.