5th February 2024

Hyperlipidaemia

Causes of primary hyperlipidaemia

Classification of lipid metabolic disorders depends on the changes in concentration of the various lipids. The following table classifies primary hyperlipidaemia into 5 types:

Table 1: Classification of lipid metabolism disorders. Own table. 

Treatment options

Lifestyle modification

• Decrease the intake of saturated fatty acids
• It has a considerably more significant effect on hypertriglyceridemia
• Strict limitations on alcohol consumption
• Reduction in the intake of rapidly resorbed carbohydrates
• Physical activity
• Mediterranean diet with additional olive oil or nuts

Statin

• It can be administered if lifestyle modification alone does not meet the target LDL cholesterol level.
• If, after 4-6 weeks of treatment, the target LDL cholesterol level still needs to be attained, the statin dose can be adjusted accordingly.
• Lifestyle modification and statin treatment should be initiated simultaneously in patients at high or very high risk of coronary events.
• Statins are generally of little use in isolated hypertriglyceridemia, as LDL cholesterol is often already very low at the outset. 

Ezetimibe

• If statin alone fails to achieve the target LDL cholesterol concentration, ezetimibe should be added.
• If there is mixed hyperlipoproteinemia, statin should perhaps be prescribed with ezetimibe to achieve the primary treatment goal of regulating LDL cholesterol.

Fibrates

• If the triglyceride level stays above 400mg/dL despite lifestyle modification, a fibrate can be given, with the best option seeming to be with fenofibrate.

Omega-3 fatty acids

• As monotherapy, there is a reduction in cardiovascular events, but no strong evidence of improved outcomes when used in combination with statins.

References

Parhofer KG. The treatment of disorders of lipid metabolism. Deutsches Ärzteblatt International. 2016 Apr;113(15):261.