Key takeaways
- Dyslipidemia describes atypical levels of lipids (fats) in the blood, such as high low-density lipoprotein (LDL) or “bad” cholesterol.
- The condition can be caused by genetic factors, as in primary dyslipidemia, or by lifestyle and medical conditions such as obesity, diabetes, and excessive consumption of unhealthy fats. This is known as secondary dyslipidemia.
- Treatment includes lifestyle changes like diet and exercise, and may require lipid-modifying medications, such as statins, to lower triglyceride and LDL levels and prevent complications.
Dyslipidemia may not always cause symptoms but it can lead to other conditions.
Many people achieve healthy levels by eating a balanced diet and through other aspects of their lifestyle. However, some require medication to prevent additional health problems.
Dyslipidemia occurs when someone has abnormal levels of lipids in their blood. While the term describes a wide range of conditions, the most common forms of dyslipidemia
- high levels of low-density lipoproteins (LDL), or bad cholesterol
- low levels of high-density lipoproteins (HDL), or good cholesterol
- high levels of triglycerides
- high cholesterol, which refers to high LDL and triglyceride levels
Lipids, or fats, are building blocks of life and provide energy to cells. Lipids include:
- LDL cholesterol, which is considered bad because it can cause plaques to form in the blood vessels.
- HDL cholesterol, which is regarded as good because it can help to remove LDL from the blood.
- Triglycerides, which develop when calories are not burned right away and are stored in fat cells.
Healthy blood lipid levels naturally vary from person to person. However, people with high levels of LDL and triglycerides or very low HDL levels tend to have a higher risk of developing atherosclerosis.
Atherosclerosis develops when hard, fatty deposits called plaques accumulate in blood vessels, making it difficult for blood to flow.
Over time, these plaques can build up and cause major circulation problems, such as heart attacks and strokes.
Dyslipidemia falls into two main categories:
Primary dyslipidemia is caused by genetic mutations that disrupt how the body processes fats and cholesterol in the blood, such as familial hypercholesterolemia (FH). This can cause very high LDL cholesterol from birth. It can also be linked to familial combined hyperlipidemia (FCH), which affects multiple lipid types.
Secondary dyslipidemia develops due to underlying conditions or factors, such as:
- diabetes
- hypothyroidism
- obesity
- chronic kidney disease
- certain medications (such as corticosteroids)
- a diet rich in saturated and trans fats
- a sedentary lifestyle
In secondary dyslipidemia, addressing the root cause often improves lipid levels.
Unless it is severe, most people with dyslipidemia are unaware that they have it. A doctor will usually diagnose dyslipidemia during a routine blood test or a test for another condition.
Severe or untreated dyslipidemia can lead to other conditions, including coronary artery disease (CAD) and peripheral artery disease (PAD).
Both CAD and PAD can cause serious health complications, including heart attacks and strokes. Common symptoms of these conditions include:
- leg pain, especially when walking or standing
- chest pain
- tightness or pressure in the chest and shortness of breath
- pain, tightness, and pressure in the neck, jaw, shoulders, and back
- indigestion and heartburn
- sleep problems and daytime exhaustion
- dizziness
- heart palpitations
- cold sweats
- vomiting and nausea
- swelling in the legs, ankles, feet, stomach, and veins of the neck
- fainting
These symptoms may get worse with activity or stress and get better when a person rests.
Talk with a doctor about chest pain, especially any of the above symptoms accompany it.
Anyone who experiences severe chest pain, dizziness, and fainting, or problems breathing should seek emergency care.
The cause can vary based on the type of dyslipidemia a person has.
Primary dyslipidemia
Genetic factors cause primary dyslipidemia, and it is inherited. Common causes of primary dyslipidemia include:
- Familial combined hyperlipidemia, which develops in teenagers and young adults and can lead to high cholesterol.
- Familial hyperapobetalipoproteinemia, a mutation in a group of LDL lipoproteins called apolipoproteins.
- Familial hypertriglyceridemia, which leads to high triglyceride levels.
- Homozygous familial or polygenic hypercholesterolemia, a mutation in LDL receptors.
Secondary dyslipidemia
Secondary dyslipidemia is caused by lifestyle factors or medical conditions that interfere with blood lipid levels over time.
Common causes of secondary dyslipidemia include:
- obesity, especially excess weight around the waist
- diabetes
- hypothyroidism
- alcohol use disorder, also known as alcoholism
- polycystic ovary syndrome
- metabolic syndrome
- excessive consumption of fats, especially saturated and trans fats
- Cushing’s syndrome
- inflammatory bowel disease, commonly known as IBS
- severe infections, such as HIV
- an abdominal aortic aneurysm
Several factors are known to increase the chances of developing dyslipidemia and related conditions. These risk factors include:
- obesity
- a sedentary lifestyle
- a lack of regular physical exercise
- alcohol use
- tobacco use
- use of illegal or illicit drugs
- sexually transmitted infections
- type 2 diabetes
- hypothyroidism
- chronic kidney or liver conditions
- digestive conditions
- older age
- a diet rich in saturated and trans fats
- a parent or grandparent with dyslipidemia
- female sex, as women tend to experience higher LDL levels after menopause
Diagnosis for dyslipidemia begins with a lipid panel blood test, which measures:
- total cholesterol
- low-density lipoprotein (LDL) cholesterol
- high-density lipoprotein (HDL) cholesterol
- triglycerides
This test requires fasting, meaning no food or drink for 9 to 12 hours beforehand.
Doctors use risk calculators like the
- age
- blood pressure
- diabetes
- smoking status
Many electronic health records (EHRs) still include atherosclerotic cardiovascular disease (ASCVD) calculators for this purpose.
Elevated lipoprotein(a) [Lp(a)] or high-sensitivity C-reactive protein (hs-CRP) can signal higher risk, so doctors may recommend earlier testing.
The 2025 ESC/EAS Focused Update and 2026 ACC/AHA Guideline may recommend a non-invasive coronary artery calcium (CAC) scan for adults ages 40 to 45 who fall into borderline or at intermediate cardiovascular risk categories. This helps refine LDL targets and create a more personalized diagnosis rather than relying solely on basic lipid levels.
A doctor will usually focus on lowering a person’s levels of triglycerides and LDL. However, treatment can vary, depending on the underlying cause of dyslipidemia and how severe it is.
Doctors may prescribe one or more lipid-modifying medications for people with very high total cholesterol levels of at least 200 milligrams per deciliter of blood.
High cholesterol is usually treated with statins, which interfere with the production of cholesterol in the liver.
If statins fail to lower LDL and triglyceride levels, or if someone develops side effects, a doctor may recommend additional medications, including:
- ezetimibe
- niacin
- fibrates
- bile acid sequestrants
- evolocumab and alirocumab
- lomitapide and mipomersen
Some lifestyle changes and supplements can help to encourage healthy blood lipid levels.
Lifestyle adjustments are often the first step recommended by doctors. These changes target diet, activity, and habits to help improve lipid levels and lower risk of complications such as a heart attack and stroke.
These changes may include:
- reducing the consumption of unhealthy fats, such as those found in red meats, full-fat dairy products, refined carbohydrates, chocolate, chips, and fried foods
- exercising regularly
- maintaining a healthy body weight, by losing weight if necessary
- reducing or avoiding alcohol consumption
- quitting smoking and other use of tobacco products
- avoiding sitting for long periods of time
- increasing consumption of healthy polyunsaturated fats, such as those found in nuts, seeds, legumes, fish, whole grains, and olive oil
- taking omega-3 oil, either as a liquid or in capsules
- eating plenty of dietary fiber from whole fruits, vegetables, and whole grains
- getting at least 6 to 8 hours of sleep a night
- drinking plenty of water
People with minor dyslipidemia usually have no symptoms. They can often manage or resolve the condition by making lifestyle adjustments.
People with dyslipidemia should contact a doctor if they experience symptoms relating to the heart or circulation, including:
- chest pains or tightness
- dizziness
- heart palpitations
- exhaustion
- swelling of the ankles and feet
- trouble breathing
- cold sweats
- nausea and heartburn
People who have severe dyslipidemia, especially those with other medical conditions, may need to manage their blood lipid levels with medication, in addition to making lifestyle changes.