Dyslipidemia

Dyslipidemia
Specialty	Cardiology

Dyslipidemia is an abnormal amount of lipids (e.g. triglycerides, cholesterol and/or fat phospholipids) in the blood. In developed countries, most dyslipidemias are hyperlipidemias; that is, an elevation of lipids in the blood. This is often due to diet and lifestyle. Prolonged elevation of insulin levels can also lead to dyslipidemia. Likewise, increased levels of O-GlcNAc transferase (OGT) may cause dyslipidemia.

Types

	Increases	Decreases
Lipid	Hyperlipidemia: lipids Hypercholesterolemia: cholesterol. Familial hypercholesterolemia is a specific form of hypercholesterolemia due to a defect on chromosome 19 (19p13.1-13.3). Hyperglyceridemia: glycerides Hypertriglyceridemia: triglycerides	Hypolipidemia Hypocholesterolemia: cholesterol
Lipoprotein	Hyperlipoproteinemia: lipoproteins (usually LDL unless otherwise specified) Honemia: chylomicrons	Hypolipoproteinemia: lipoproteins Abetalipoproteinemia: beta lipoproteins Tangier disease: high density lipoprotein
Both	Combined hyperlipidemia: both LDL and triglycerides

Diagnosis

Classification

Physicians and basic researchers classify dyslipidemias in two distinct ways:

Presentation in the body (including the specific type of lipid that is increased)
Underlying cause for the condition (genetic, or secondary to another condition). This classification can be problematic, because most conditions involve the intersection of genetics and lifestyle issues. However, there are a few well-defined genetic conditions that are usually easy to identify.

Fredrickson Classification:[1]

Phenotype	I	IIa	IIb	III	IV	V
Elevated Lipoprotein	Chylomicron	LDL	LDL and VLDL	IDL	VLDL	VLDL and chylomicrons

Screening

Testing the general population under the age of 40 without symptoms is of unclear benefit.[2][3]

Management

Statins

Fibrates

Ezetimibe

References

Fredrickson DS, Lees RS. A system for phenotyping hyperlipoproteinemia. Circulation 1965;31:321-327.
Bibbins-Domingo, Kirsten; Grossman, David C.; Curry, Susan J.; Davidson, Karina W.; Epling, John W.; García, Francisco A. R.; Gillman, Matthew W.; Kemper, Alex R.; Krist, Alex H.; Kurth, Ann E.; Landefeld, C. Seth; Lefevre, Michael; Mangione, Carol M.; Owens, Douglas K.; Phillips, William R.; Phipps, Maureen G.; Pignone, Michael P.; Siu, Albert L.; Siu, A. L. (August 9, 2016). "Screening for Lipid Disorders in Children and Adolescents". JAMA. 316 (6): 625–33. doi:10.1001/jama.2016.9852. PMID 27532917.
Chou, R; Dana, T; Blazina, I; Daeges, M; Bougatsos, C; Jeanne, TL (18 October 2016). "Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 165 (8): 560–564. doi:10.7326/m16-0946. PMID 27538032.

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[1] Fredrickson DS, Lees RS. A system for phenotyping hyperlipoproteinemia. Circulation 1965;31:321-327.

[2] Bibbins-Domingo, Kirsten; Grossman, David C.; Curry, Susan J.; Davidson, Karina W.; Epling, John W.; García, Francisco A. R.; Gillman, Matthew W.; Kemper, Alex R.; Krist, Alex H.; Kurth, Ann E.; Landefeld, C. Seth; Lefevre, Michael; Mangione, Carol M.; Owens, Douglas K.; Phillips, William R.; Phipps, Maureen G.; Pignone, Michael P.; Siu, Albert L.; Siu, A. L. (August 9, 2016). "Screening for Lipid Disorders in Children and Adolescents". JAMA. 316 (6): 625–33. doi:10.1001/jama.2016.9852. PMID 27532917.

[3] Chou, R; Dana, T; Blazina, I; Daeges, M; Bougatsos, C; Jeanne, TL (18 October 2016). "Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 165 (8): 560–564. doi:10.7326/m16-0946. PMID 27538032.