Hypercholesterolemia vs Hyperlipidemia: What Are the Differences?

The terms hyperlipidemia and hypercholesterolemia are often used interchangeably but the two conditions are different, despite having some overlap.

Hyperlipidemia is an umbrella term that refers to any of several acquired or genetic disorders that result in a high level of lipids—fats, cholesterol, and triglycerides—circulating in the blood.

Alternatively, hypercholesterolemia is a type of hyperlipidemia that is characterized by high levels of good, or non-high density lipoproteins (non-HDL) cholesterol and bad, or low-density lipoprotein (LDL) cholesterol in your blood. Hypercholesterolemia is especially concerning because excess LDL can clog your arteries, putting you at risk for a heart attack or stroke.

This article will discuss the differences between hypercholesterolemia and hyperlipidemia, including how each condition is diagnosed and treated. 

Symptoms

Hyperlipidemia and hypercholesterolemia are especially ominous because both usually occur with no symptoms unless detected through blood work.

If symptoms do occur, it usually means cholesterol has built up in the arteries and is causing problems for the heart. The results may be catastrophic. Symptoms may include:

• Chest pain
• Aortic aneurysm (bulging of the body's largest vein)
• Heart attack
• Peripheral artery disease (blockage in one or more arteries that carry blood from the heart to the extremities)
• Stroke 

Hypercholesterolemia is also associated with xanthelasmas, yellow fatty deposits that build up under the skin. They are often found around one's hands, elbows, knees, or eyelids. 

Causes

The way that hyperlipidemia and hypercholesterolemia present is similar, but their underlying causes are different. Knowing the difference between the two is integral to choosing the right treatment. 

Sometimes high cholesterol is the result of unhealthy lifestyle choices, and that kind is preventable and treatable with lifestyle interventions.

In other cases, such as in the hereditary form of hypercholesterolemia, extremely high levels of LDL can’t be controlled simply through diet and exercise.

Hyperlipidemia

Hyperlipidemia is most commonly associated with high-fat diets, a sedentary lifestyle, obesity, and diabetes. In some cases, lifestyle modifications alone can greatly lower cholesterol levels, significantly reducing the risk of developing atherosclerosis and coronary heart disease.

Hypercholesterolemia

Hypercholesterolemia can be the result of poor diet choices, lack of exercise, and living a sedentary lifestyle or it can be acquired from a parent.

Familial hypercholesterolemia (FH) is an inherited disorder that leads to significantly elevated low-density lipoprotein (LDL) cholesterol (LDL-C) or “bad cholesterol” and an increased risk of early onset of coronary artery disease if not sufficiently treated. It is fairly common, affecting 1 in every 250 people.

Individuals with FH inherit a mutated LDL recycling gene from one or both of their parents.

Your healthcare provider may suspect that you have familial hypercholesterolemia if they detect the following in your personal or family history or physical exam:

• Very high cholesterol levels. For example, LDL cholesterol might be over 190 mg/dL. Total cholesterol might be over 300 mg/dL.
• A family history of high cholesterol.
• A family history of sudden heart attack or stroke, a sign of early CAD.
• Certain results from a physical exam like the presence of xanthomas, a skin condition in which small bumps of fat appear under the skin.

If a case of FH is suspected, DNA testing for mutations on one of the following three genes (LDLR, APOB, and PCSK9) may be recommended.

Diagnosis

A blood test to check lipid levels (called a lipid panel) is used to diagnose both hyperlipidemia and hypercholesterolemia.

Results are usually reported as levels of LDL cholesterol (normal range <130mg/dL); VLDL (very low density lipoprotein) cholesterol (normal range <31mg/dL); HDL cholesterol (normal range >40 mg/dL); as well as total cholesterol (normal range <200mg/dL), of which all non-HDL cholesterol should be <130mg/dL.

A diagnosis of hyperlipidemia is made when total cholesterol levels are above 200 mg/dL. A diagnosis of hypercholesterolemia is made when LDL cholesterol levels are above 130 mg/dL. 

A physical exam and attaining a family history may also be helpful in making an accurate diagnosis of either condition, but especially familial hypercholesterolemia, a hereditary condition that results in high LDL levels. Dysfunctional recycling of LDL can lead to xanthomas, or yellow, fatty deposits on the elbows and eyelids. The presence of xanthomas on physical examinations is highly suggestive of FH. 

FH is usually identified based on the aforementioned criteria, however, there are genetic tests that can identify mutations in the LDLR, apoB, or PCSK9 genes to confirm the diagnosis.

Treatment

The presence of hyperlipidemia, especially hypercholesterolemia, predisposes you to heart disease, one of the leading causes of death in the United States.

If you have high lipid levels in your blood, a healthcare professional may use the ASCVD Risk Calculator to assess your risk of a coronary event, such as a heart attack, in the next 10 years.

Lifestyle modification in people with hyperlipidemia forms a very important backbone of the treatment plan. Therapeutic lifestyle changes comprise diet, weight management, and increased physical activity.

The impacts of lifestyle changes can be profound—dietary modifications may lead to a reduction of 8% to 15% in LDL cholesterol and weight reduction of 10 or more pounds can improve insulin resistance and blood pressure.

Regular exercise, such as walking briskly for 30 minutes, has been shown to improve cardiovascular fitness and should be incorporated into every treatment plan.

That said, prescription medication is usually also needed to get cholesterol levels down to optimal levels. Cholesterol-lowering drugs called statins are a mainstay of treatment for both hyperlipidemia and hypercholesterolemia.

Statins are rarely effective alone, especially in those with very high LDL levels, as commonly seen in FH. In cases where LDL levels are sky-high, additional medications such as fibrates, bile acid sequestrants, nicotinic acid, and selective inhibitors of cholesterol absorption (like newer medications called PCSK9 inhibitors) may be needed.

Prevention

The same lifestyle changes that are used to treat hyperlipidemia and hypercholesterolemia, can also be used as preventative measures, especially for non-inherited forms of the disease. These lifestyle changes include:

• Eating a heart-healthy diet. The American Heart Association recommends limiting saturated fat to less than 6% of daily calories and minimizing the amount of trans fat you eat by cooking your meals, limiting processed foods, red meat and whole milk, and emphasizing more fruits, vegetables, whole grains, poultry, fish, and nuts in your diet.
  
• Becoming more physically active. The US Preventive Services Task Force recommends at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week to lower cholesterol and blood pressure.
• Quitting smoking. Smoking lowers HDL levels. Quitting increases HDL levels and lowers LDL levels.
• Losing weight. Shedding 5%-10% of your body weight has been shown to significantly reduce triglycerides, total cholesterol, and LDL cholesterol levels.

A Word From Verywell

Ideally, everyone would lead heart-healthy lifestyles and not have to worry about high levels of fat in their blood but that isn’t the case. Even when you do everything right, you may still experience high cholesterol levels. Fortunately, hyperlipidemia and hypercholesterolemia are highly treatable conditions, especially when they are diagnosed and treated early. 

Whether you have hyperlipidemia or hypercholesterolemia, lifestyle changes will be a staple of your treatment plan. Incorporating more fruits and vegetables in your meals is a great way to increase your intake of fiber and heart-protective antioxidants. Adding other dietary components—such as fish oil, soluble fiber, and soy protein—have been shown to improve lipid levels and should be considered as well.

Living an active life and losing weight will help lower your risk of developing coronary artery disease and cardiovascular complications; and taking medications (if needed) may help to regulate your lipid levels if they remain high.