Can Diseases or Drugs Cause High Cholesterol?

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The chances are that if you have high cholesterol, it is the result of common factors like genetics, diet, lack of exercise, age, and gender. But, in some cases, high cholesterol can be caused by diseases you get or the drugs you take.

Known as secondary or acquired hyperlipidemia, this condition is usually a condition that changes your lipid profile, including your cholesterol and triglyceride levels. If secondary hyperlipidemia is left untreated, you run the same health risks—including stroke, heart attack, and cardiovascular disease—as someone with primary hyperlipidemia.

Primary and secondary hyperlipidemia can often co-occur and is especially troublesome when triglyceride levels are consistently elevated. In combination, these two conditions can lead to pancreatitis, an inflammation of the pancreas that is often life-threatening.

Illnesses Linked to Hyperlipidemia

By far, the diseases most commonly linked to secondary hyperlipidemia are diabetes and prediabetes. Both are common in people with obesity, which affects roughly 40% of adults in the United States today.

People with diabetes typically have elevated levels of a type of "bad" cholesterol called small dense low-density lipoprotein (sdLDL). This a subset of LDL cholesterol is heavier and clings more readily to the wall of arteries, causing atherosclerosis ("hardening of the arteries").

The challenge in people with diabetes is that LDL levels can often look normal when tested. It is only when looking at sdLDL that the true risk is revealed. High triglycerides and low high-density lipoprotein (HDL) cholesterol are generally predictive of elevated sdLDL.

In addition to diabetes and prediabetes, illnesses associated with secondary hyperlipidemia include:

Any disorder that affects the endocrine system (which regulates hormone production) or metabolism (the conversion of calories to energy) can increase the risk of secondary hyperlipidemia.

In other cases, the links between primary illnesses and acquired hyperlipidemia are not well understood.

Drugs Linked to Hyperlipidemia

Certain drugs and hormonal therapies are associated with secondary hyperlipidemia. They typically interfere with metabolism and/or suppress the endocrine system.

The body uses cholesterol to produce hormones such as estrogen, testosterone, and cortisol. Drugs that increase hormone levels, such as hormone replacement therapy (HRT) used in postmenopausal women, can cause cholesterol to accumulate because the body no longer needs cholesterol to synthesize hormones.

In other cases, a drug may impair hormone-producing glands, alter the chemistry of blood, or impede the way in which lipids are cleared from the body.

Estrogen and corticosteroids tend to raise the levels of triglycerides and "good" HDL cholesterol, whereas oral anabolic steroids will often lower HDL levels. Birth control pills can raise cholesterol levels and increase the risk of atherosclerosis, depending on the type and the progestin/estrogen dosage.

Beta-blockers, a class of drugs commonly prescribed for high blood pressure, glaucoma, and migraines, typically elevate triglycerides while lowering HDL. Retinoids used to manage psoriasis and certain types of skin cancer are can often increase LDL and triglyceride levels.

Diuretic drugs, prescribed to reduce the buildup of excess body fluids, typically causes an increase in both LDL and triglyceride levels.

The way in which each of these drugs affects the different lipid levels—including "bad" LDL and triglycerides and "good" HDL—can vary.

Lipid Abnormalities Associated With Common Drugs
Drug Triglycerides LDL cholesterol  HDL cholesterol
Loop diuretics 5% to 10% increase 5% to 10% increase no effect
Thiazide diuretics 5% to 10% increase 5% to 15% increase no effect
Beta blockers no effect 14% to 40% increase 15% to 20% increase
Estrogen 7% to 20% decrease 40% increase 5% to 20% increase
Anabolic steroids 20% increase no effect 20% to 70% decrease
Protease inhibitors 15% to 30% increase 15% to 200% increase no effect
Hepatitis C direct-acting antivirals (DAAs) 12% to 27% increase no effect 14% to 20% decrease
Cyclosporine 0% to 50% increase 0% to 70% increase 0% to 90% increase
Retinoids 15% increase 35% to 100% increase no effects
Human growth hormone (HGH) 10% to 25% increase no effect 7% increase

The discontinuation of the offending drug can often improve cholesterol levels. But clearly, this is not possible in all cases.

In such an event, there may be complementary drugs that can aid in the reduction of blood lipids, or a simple dose adjustment may be all that is needed to get things right. At other times, lifestyle changes may be needed, including the introduction of routine exercise, a low-fat diet, and a structured weight loss plan.

A Word From Verywell

Failure to treat secondary hyperlipidemia can result in serious health problems. The current body of research suggests that acquired lipid disorders place people at a higher risk for heart disease than the primary lipid disorders.

If your doctor is not able to bring down your cholesterol by traditional, ask for a referral to a lipidologist who can help.

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Article Sources

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