CULAR DISEASE(PVD). Hyperlipidemia also can cause
health conditions such as PANCREATITIS. Some forms
of hyperlipidemia are familial or hereditary and
may manifest regardless of lifestyle. Medications
can cause hyperlipidemia as well, notably oral
contraceptives (birth control pills), estrogen ther-
apy, thiazide diuretics, and corticosteroids. Hyper-
lipidemia may also be a sign of other health
conditions such as CUSHING’S SYNDROME, DIABETES,
LIVERdysfunction, and SYSTEMIC LUPUS ERYTHEMATO-
SUS (SLE). In most people who have hyperlipi-
demia, however, it appears that lifestyle factors
interact with genetics.
Doctors measure lipid levels in the blood and
consider them individually as well as in correla-
tion to each other in determining the extent of
cardiovascular risk they pose. There are five types,
or classifications, of hyperlipidemia that have
unique presentations, genetic factors, and charac-
teristic progressions. The five types of hyperlipi-
demia are
- type I, a rare inherited lipid disorder sometimes
called apolipoprotein C-II deficiency, in which
very low density lipoprotein (VLDL) triglyc-
erides and lipids called chylomicrons accumu-
late in the bloodstream - type II, a common group of familial or acquired
lipid disorders, sometimes called hypercholes-
terolemia, in which low-density lipoprotein
(LDL) cholesterol levels in the blood are ele-
vated, and there may be apolipoprotein B defi-
ciency - type III, an uncommon familial lipid disorder in
which VLDL and total cholesterol are elevated,
usually resulting from apolipoprotein E defi-
ciency - type IV, a common familial or acquired lipid
disorder in which blood lipid elevations are
associated with OBESITYand decline with weight
loss - type V, an uncommon lipid disorder in which
triglycerides are extremely elevated, though
other blood lipid levels are fairly normal, and
that frequently causes pancreatitis
Most forms of hyperlipidemia can occur with-
out evidence of familial or hereditary connections.
Symptoms and Diagnostic Path
Hyperlipidemia itself does not cause symptoms.
Doctors detect hyperlipidemia through blood tests,
conducted after an 8- to 12-hour fast, that meas-
ure blood lipid levels. The pretest fast is important
to remove any dietary influences. Elevated blood
lipid levels are diagnostic. When blood lipid levels
are extremely high and other risks for CARDIOVAS-
CULAR DISEASE(CVD) exist, the doctor may recom-
mend further evaluation to look for CAD, PVD,
and other atherosclerotic conditions.Treatment Options and Outlook
Regardless of the cause of elevated blood lipids, the
important therapeutic goal is to reduce them. For
people who have mild to moderate elevations and
no other cardiovascular disease risk factors (includ-
ing family history of hyperlipidemia), lifestyle
changes alone may be enough to bring lipid levels
down to acceptable ranges. Doctors are generally
willing to give this approach about two months to
lower blood lipid levels. When lipid levels remain
elevated despite lifestyle changes, or the person
cannot make adequate lifestyle changes, health
experts recommend lipid-lowering medications.
Lowering blood lipids results in a significant
decrease in cardiovascular risk, especially for early
CAD and HEART ATTACK(before age 40).MEDICATIONS TO TREAT HYPERLIPIDEMIA
(LIPID-LOWERING MEDICATIONS)
Statins
atorvastatin fluvastatin lovastatin
(Lipitor) (Lescol) (Mevacor)
pravastatin simvastatin
(Pravachol) (Zocor)
Fibrates
clofibrate fenofibrate gemfibrozil
(Atromid-S) (Tricor) (Lopid)
Bile acid sequestrants
cholestyramine colesevelam colestipol
(Questran, Prevalite) (WelChol) (Colestid)
Selective cholesterol absorption inhibitors
ezetimibe (Zetia)Many doctors recommend niacin, either alone
or in combination with lipid-lowering medica-
tions, to help lower blood lipid levels. Niacinhyperlipidemia 65