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INTRODUCTION

Dyslipidemia is defined as elevated total cholesterol, low-density lipoproteins (LDL) or triglycerides (TGs), low high-density lipoproteins (HDL), or a combination of these abnormalities1,2. Total cholesterol is a composite of different types of lipoproteins. Cholesterol is transported as lipoproteins in the blood stream as complexes of lipid and proteins. The three major classes of lipoproteins consist of LDL, HDL, and very low-density lipoproteins (VLDL). VLDL supply the body tissues with triglycerides (TGs). Non-HDL is equal to the difference between the total cholesterol and HDL. Increases in non-HDL, LDL, and TG contribute to higher risk for coronary heart disease (CHD), and cerebrovascular and peripheral vascular arterial diseases. As fat deposits and accumulates on the wall of arteries, over time, it can lead to atherosclerosis. Non-HDL cholesterol is a better predictor of atherosclerotic cardiovascular disease (ASCVD) events than LDL. Elevated TGs are a rare risk factor associated with acute pancreatitis.

Dyslipidemia can be due to genetic predisposition, also known as primary or familial dyslipidemia. Secondary causes of dyslipidemia can be the result of an unhealthy diet, drugs, diseases, and other conditions associated with metabolism. Lifestyle modification, including healthy diet and regular exercise, may correct secondary dyslipidemia. Medications may be added together with diet and lifestyle modification to achieve the optimal lipid lowering effect. Some common secondary causes of dyslipidemia are listed in table 1 below.

Table 1Secondary Causes of Dyslipidemia1,2

CLINICAL PRESENTATION

Dyslipidemia is generally asymptomatic prior to a clinically evident disease1. Some signs of dyslipidemia include abdominal pain, pancreatitis, high blood pressure, waist size > 40 inches (men) and waist size > 35 inches (women). Laboratory tests include levels of different types of lipoproteins. A fasting lipid panel is preferred. Clinical presentation typically shows elevated total cholesterol (TC), LDL, and/or TG, or low HDL. LDL can be calculated using the Friedewald equation, LDL = TC – HDL – (TG/5). This formula may be used when TG is < 400 mg/dL.

CLASSIFICATION OF CHOLESTEROL LEVELS

Table 2 lists the ranges of different types of cholesterol.

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