What Is Secondary (Acquired) Hyperlipidemia?

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Secondary hyperlipidemia is an abnormal rise in blood lipids (fats), including cholesterol and triglycerides. It does not cause discernible symptoms but can increase the risk of heart attack and stroke. Also known as acquired hyperlipidemia, secondary hyperlipidemia differs from primary hyperlipidemia, which is an inherited disorder, in that it develops as a result of lifestyle, underlying health conditions, or medication.  It is diagnosed via a blood test called a lipid panel that measures the amount of fats in the blood. Secondary hyperlipidemia is not treated directly, but rather managed by modifying unhealthy behaviors and using cholesterol-lowering drugs.

Symptoms

Hyperlipidemia does not cause symptoms you're likely to "feel," but you may notice changes in how your body functions as the disorder progresses.

Many of these changes are related to the build-up of fatty deposits in the blood vessels (atherosclerosis), which can lead to high blood pressure (hypertension), heart attack, stroke, and other related conditions.

Depending on the severity of atherosclerosis, symptoms may include shortness of breath, fatigue (particularly with exertion), muscle weakness, chest pain, or pain in an arm, leg, or wherever a vessel may be blocked.

If hyperlipidemia is advanced, it can cause yellowish fatty nodules under the skin called xanthomas, especially around the eyes, knees, and elbows. There may also pain or a feeling of fullness in the right upper abdomen caused by enlargement of the liver pain or fullness in the left upper abdomen associated with enlargement of the spleen. The development of a light-colored ring around the cornea called arcus senilis is another possible symptom.

Causes

Doctors sometimes classify the causes of secondary hyperlipidemia according to the four D's: diet, disorders of metabolism, diseases, and drugs.

Diet

This includes eating too much "bad" low-density lipoprotein (HDL) cholesterol and too little "good" high-density lipoprotein (HDL) cholesterol. Excessive amounts of saturated fat and trans fats from red meat, processed meats, commercial baked goods, and fried foods also can contribute to secondary hyperlipidemia.

Risk factors such as smoking and heavy alcohol use also may contribute to the development and severity of secondary hyperlipidemia.

Metabolic Disorders and Diseases

A metabolic disorder occurs when abnormal chemical reactions in the body disrupt the process by which energy is obtained from food. It may be acquired, such as with metabolic syndrome and insulin resistance, or congenital. In either instance, hyperlipidemia that arises as a result of a metabolic disorder is considered secondary even if the cause of the disorder is genetic.

Several metabolic disorders are associated with secondary hyperlipidemia:

  • Diabetes mellitus (including type 1 diabetes, type 2 diabetes, and prediabetes) is associated with abnormal increases in triglycerides and very low density lipoprotein (VLDL) cholesterol.
  • Kidney diseases (including kidney failure, cirrhosis, chronic hepatitis C, and nephrotic syndrome) are associated with high triglycerides and VLDL.
  • Hypothyroidism (low thyroid function) is associated with high LDL.
  • Cholestatic liver disease (in which bile ducts are damaged) is linked to high LDL.

Certain autoimmune diseases such as Cushing's syndrome and lupus also are associated with secondary hyperlipidemia. Even eating disorders such as anorexia nervosa can cause abnormal elevations of total cholesterol and LDL.

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.

Drugs

The body uses cholesterol to produce hormones such as estrogen, testosterone, and cortisol. Drugs that increase hormone levels, such as hormone replacement therapy for treating menopause, can cause cholesterol to accumulate because the body no longer needs it to synthesize hormones. In other cases, a drug may impair hormone-producing glands, alter the chemistry of blood, or interfere with how lipids are cleared from the body.

Among the drugs associated with secondary hyperlipidemia:

  • Estrogen tends to raise the levels of triglycerides and HDL.
  • 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, can often increase LDL and triglyceride levels.
  • Diuretic drugs, used to reduce the buildup of body fluids, typically causes an increase in both LDL and triglyceride levels.
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

Diagnosis

Hyperlipidemia, both primary and secondary, is diagnosed with a group of blood tests called a lipid panel that measures how many lipids are in the blood after fasting for around 12 hours.

The lipid panel is measured in values of milligrams per deciliters (mg/dL). According to the Centers for Disease Control and Prevention (CDC), the desirable values for cholesterol and triglycerides are:

  • Total cholesterol: less than 200 mg/dL
  • LDL cholesterol: less than 100 mg/dL
  • Triglyceride: less than 150 mg/dL
  • HDL cholesterol: greater than or equal to 60 mg/dL

In addition to a lipid panel, family history, age, gender, weight, current health, medical conditions, and lifestyle factors such as smoking are considered.

In some cases, a doctor may conclude that a person's lipid goals should be lower than those outlined by the CDC if they have multiple risk factors for heart disease.

Treatment

Because secondary hyperlipidemia is acquired, an important aspect of treatment is lifestyle modification. Cholesterol-lowering drugs also are key.

Most of the underlying metabolic causes, like diabetes and hypothyroidism, are chronic and are not so much "cured" as they are controlled. Others, like hepatitis C, can be cured, although damage to the liver may result in elevated lipid levels even after treatment.

Medication-induced hyperlipidemia can often be eliminated by stopping or switching the drug involved or lowering the dose. When this isn't possible because the drug is necessary to treat a chronic illness, traditional interventions may be recommended to reduce blood lipids. The same would apply to treating hyperlipidemia caused by disease or a metabolic disorder.

Failure to treat secondary hyperlipidemia can result in serious health problems. Research suggests secondary hyperlipidemia places people at a higher risk for heart disease than primary hyperlipidemia.

Diet and Lifestyle Modifications

The first step in addressing hyperlipidemia is modifying the lifestyle factors that contribute to abnormally high blood fats—poor diet, lack of exercise, smoking, and the overuse of alcohol.

Among the lifestyle interventions a doctor may recommend:

  • Diet: Reduce intake of saturated fats to less than 7% of total daily calories and total fat to less than 30%. Replace saturated fats with healthier polyunsaturated or monosaturated fats. Increase intake of fruit and vegetables, whole grains, low-fat dairy, and oily fish rich in omega-3 fatty acids.
  • Weight loss: Weight loss is currently recommended for obese people with a body mass index (BMI) over 30 and overweight people with a BMI between 25 and 29.9 who have at least two risk factors for cardiovascular disease (such as smoking, high blood pressure, family history, or diabetes).
  • Exercise: The general consensus is that at least 30 minutes of moderate-intensity exercise should be performed three to four times per week.
  • Smoking: Kicking this habit is possibly the single most significant lifestyle change a person can make to reduce the risk of cardiovascular disease. Stop smoking aids like nicotine replacement therapies and Zyban (bupropion) can significantly improve chances of quitting.
  • Alcohol: The American Heart Association recommends limiting alcohol intake to no more than two drinks per day for men and one drink per day for women.

Medications

There are a variety of medications a doctor may consider if you cannot bring down your cholesterol and triglyceride levels by diet and lifestyle changes alone. Among them:

  • Statin drugs are a class of medications that lower LDL levels by reducing the amount of cholesterol produced by the liver.
  • Bile acid sequestrants are used to clear bile from the body and, by doing so, force the liver to produce more bile and less cholesterol.
  • Fibrates are primarily used to reduce triglyceride levels and increase HDL levels.
  • Niacin (nicotinic acid) is a prescription form of this B vitamin that may help reduce LDL and increase HDL (although it has not proven to be any more effective in doing so if combined with statins).

A newer class of cholesterol-lowering drugs, called PCSK9 inhibitors, are reserved for the treatment of primary hyperlipidemia (including familial hypercholesterolemia), rather than secondary hyperlipidemia.

A Word From Verywell

Even though secondary hyperlipidemia is something you acquire, it shouldn't suggest that you are "to blame" for your condition. Some of the causes are beyond your control and simply require you to step in to improve your blood lipid profile. Even if diet, obesity, lack of exercise, or smoking are the primary causes of hyperlipidemia, there are steps you can take to reduce these risks.

Work with your doctor to find the best means to treat your condition, and then stick with it. If your doctor is unable to lower your lipids by traditional means, ask for a referral to a lipidologist who can help.

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