What is Hyperlipidemia?

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Hyperlipidemia is a common condition that occurs when there are too many fats (called lipids) in your blood. Cholesterol and triglycerides are two types of fat that can build up in the arteries, restricting blood flow and increasing your chances of heart disease, stroke, or other health issues.

Many different factors can increase your chances of developing hyperlipidemia. While some can’t be helped (your family history, for instance), others can be controlled, like diet and exercise. Many people who are diagnosed with hyperlipidemia can lower their cholesterol and triglyceride levels by eating healthier, being more physically active, and maintaining a healthy weight. Others may need medication to keep their lipids at healthy levels.

Lifestyle changes that reduce cholesterol
Verywell / Jessica Olah

Symptoms

Having hyperlipidemia alone won’t make you feel sick, so many people do not realize their cholesterol and triglycerides are too high until their doctor diagnoses it from routine lab results. On rare occasions, hyperlipidemia can lead to xanthomas, which are yellowish fat nodules forming under the skin near the eyes, elbows, hands, buttocks, or knees. Other uncommon manifestations include an enlarged liver or spleen, or pale rings around the iris in the eye.

If left uncontrolled, hyperlipidemia can lead to other serious issues that are more noticeable, including high blood pressure, heart attack, and blood clots.

Having high levels of triglycerides along with high LDL cholesterol can increase your risk of stroke and heart attack.

Causes

While excess lipids can put you at risk for cardiovascular disease, they also play an important role in your body’s function. Cholesterol is a type of waxy fat that your body makes in the liver or that you absorb from foods. It’s a critical building block for the body's cells and is vital in producing hormones and digestive fluids.

Triglyercides are a type of fat that provides energy for cell function as well as the metabolism of alcohol. They are released into your bloodstream from food that contains fat and from fat stores in the body. Triglycerides also come from eating excess calories, particularly calories from carbohydrates—calories that the body does not use immediately get turned into triglycerides and stored.

The risk of heart disease increases when a high level of circulating lipids become attached to low-density lipoproteins (LDL cholesterol, known as "bad cholesterol”) or very low-density lipoproteins (VLDL). LDL carries cholesterol to your tissues while VLDL carries mainly triglycerides to your tissues. Both LDL and VLDL cholesterol contribute to the buildup of plaque in the arteries. That plaque, made up of fat, cholesterol, calcium, and other matter, hardens and narrows the arteries.

On the other hand, cholesterol attached to high-density lipoprotein (HDL cholesterol) represents excess cholesterol that is being removed from the tissues. For this reason, HDL cholesterol is known as "good cholesterol."

Over time, the build-up of cholesterol-laden plaques can lead to heart attacks, strokes, or blood clots.

Cholesterol and triglyceride levels can be influenced by a wide range of factors, including family history, age, medical conditions, medications, and health behaviors.

Family History

You share a lot with your family members. Your genetic makeup can impact your risks for certain health conditions known to contribute to hyperlipidemia, such as obesity or diabetes. Your family can also shape many of your behaviors and choices, especially when it comes to diet and exercise. As a result, if you have relatives with a history of hyperlipidemia, you are more likely to develop it, too.

Certain genetic conditions can leave you predisposed to having hyperlipidemia, including:

  • Familial combined hyperlipidemia—Familial combined hyperlipidemia is the most common genetic disorder that can lead to an increase in body fats. It causes high levels of cholesterol and triglycerides and is exacerbated by other chronic conditions like alcoholism, diabetes, and hypothyroidism.
  • Familial hypercholesterolemia—This inherited disorder prevents your body from being able to remove LDL cholesterol from your blood, resulting in abnormally high levels of the "bad" cholesterol in the body.
  • Familial dysbetalipoproteinemia—Those with familial dysbetalipoproteinemia have a genetic defect that leads cholesterol and triglycerides to build up in the blood. Like familial combined hyperlipidemia, certain health issues can make familial dysbetalipoproteinemia worse.

Age and Sex

As you age, it gets harder for your body to clear excess cholesterol from the blood, and easier for risky levels to build up. Someone’s sex can also play a role. Men, on average, tend to have less “good” cholesterol than women, while women (especially under 55 years old) often have less “bad” cholesterol.

The older you get, the more likely you are to be diagnosed with hyperlipidemia, but younger generations aren’t immune.

In some cases, children with sedentary lifestyles and poor diets can develop hyperlipidemia. Diabetes, obesity, kidney disease, and some thyroid diseases can also cause high cholesterol and high levels of triglycerides in kids and teenagers.

Medical Conditions

Having certain medical conditions has been shown to increase your risk of having abnormal cholesterol and triglyceride levels:

Having diabetes, in particular, can impact your risk for developing high cholesterol. While it's not exactly clear why this is, some research indicates that high levels of insulin may negatively affect cholesterol levels by upping the amount of "bad" cholesterol and reducing the amount of "good" cholesterol. This is especially true for those with type 2 diabetes.

Medications

Medications might also increase the likelihood of developing hyperlipidemia. Taking meds like beta-blockers, diuretics (water pills), certain birth control pills, or some anti-depressants may contribute to increased blood cholesterol and triglyceride levels.

Health Behaviors

Certain lifestyle decisions can impact your cholesterol and triglyceride levels, including what you eat, how often you exercise, and whether you smoke.

  • Dietary choices: You absorb some cholesterol from certain foods, including products high in saturated fats and trans fats. In addition, when you eat more calories than you can burn off, those extra calories are changed to triglycerides, which can result in high levels in your blood. 
  • Physical activity: Low physical activity can result in weight gain and cause LDL cholesterol and triglyceride levels to increase.
  • Weight: Being overweight or obese can change the way your body uses cholesterol, resulting in levels building up in your blood. Excess weight can also lead to high triglycerides, which are stored in your fat cells.
  • Smoking: Smoking won’t cause your LDL cholesterol to spike, but it can cause your HDL cholesterol levels (the good kind) to drop, as well as damage arteries and hasten how fast they harden.
  • Alcohol use: Drinking heavily increases levels of both cholesterol and triglycerides.

Diagnosis

Hyperlipidemia doesn’t cause any physical signs or symptoms of the condition, so your doctor must rely on blood tests to spot it. The most common way to diagnose high cholesterol is with a lipid panel.

Lipid Panel

A simple blood test called a lipid panel can be used to check the levels of cholesterol and triglycerides in your blood. The test uses a blood draw taken after fasting for roughly 12 hours.

Blood Levels That May Lead to Diagnosis

  • Total cholesterol is over 200 mg/dL (milligrams per deciliter)
  • LDL cholesterol is over 100 mg/dL
  • HDL cholesterol is under 60 mg/dL
  • Triglycerides are over 150 mg/dL

If your blood work comes back normal, your health care provider might want to run the tests periodically—every four to six years or so—to keep tabs on any trends signaling your cholesterol and triglyceride levels are on the rise.

While a total cholesterol count over 200 mg/dL generally indicates high cholesterol, your doctor might take other factors into consideration (like age and medical history) before making a diagnosis based on your results. Your doctor will then use your results to set cholesterol level goals with you, as well as formulate your treatment plan.

Treatment

Some people are able to lower their cholesterol and triglyceride levels by making some healthy lifestyle changes like improving diet and exercising more. Others might also need the help of medications. What your doctor recommends for you will depend a lot on your lab results, health history, and any other risk factors that might affect your cardiovascular health.

Lifestyle Changes

You may be able to lower your cholesterol and triglyceride levels by making some lifestyle changes to eat better, exercise more, and maintain a healthy weight. These include:

  • Diet: Limit foods that are high in saturated or trans fats, like certain meats, tropical vegetable oils (like palm oil), and cheese. Choose lower-fat and unsaturated-fat foods like fruits, vegetables, lean proteins (like fish), and nuts. If you have a high triglyceride level, try eating fewer calories since excess calories are converted to triglycerides and stored as fat. 
  • Exercise: Staying physically active can help lower the amount of cholesterol and triglycerides in your blood. The American Heart Association recommends getting at least 150 minutes of moderate-intensity aerobic exercise each week, or 75 minutes of vigorous-intensity aerobic exercise, either of which should preferably be spread throughout the week. One study found that 12 weeks or more of aerobic exercise caused triglycerides levels to fall more than 3% and LDL cholesterol to fall by 5%. 
  • Weight loss: Being overweight or obese can contribute to high levels of cholesterol and triglycerides in your blood. Getting down to a healthy body mass index can put your body in a better position to excrete and process lipoproteins more efficiently and prevent them from building up in the bloodstream. Fortunately, the best path to losing weight is through a healthy diet and frequent exercise, both of which will also help to reduce cholesterol and triglyceride levels.
  • Quitting smoking: Smoking damages your blood vessels and makes them more likely to collect fatty deposits. Quitting can greatly reduce your risk of heart attack and stroke.

Medications

If you aren’t able to get your cholesterol and triglyceride levels down through lifestyle changes, your doctor might prescribe cholesterol-lowering medications. These drugs often need to be taken long term and should only be used as directed by a physician. Here are the most common medications used to treat high cholesterol and triglycerides:

  • Statins—Statin drugs lower LDL cholesterol by reducing the amount of cholesterol made by the liver. In addition, they have other important effects that reduce cardiovascular risk independent of their cholesterol-lowering capabilities. In fact, statins are the only class of cholesterol-reducing medications that, so far, have been clearly shown in clinical studies to reduce cardiovascular risk.
  • Bile acid sequestrants—These medications remove bile acids from the body. When the liver tries to compensate by making more bile, it uses up some of the cholesterol in the bloodstream.
  • Niacin (nicotinic acid)—Some prescription forms of this B vitamin increase HDL cholesterol while also lowering levels of LDL cholesterol and triglycerides. However, recent studies show that niacin fails to substantially reduce cardiac risk when combined with statins, and in addition, pharmaceutical niacin can cause serious risks. Most doctors no longer prescribe it for cholesterol in people who can take statins.
  • Fibrates—These medications primarily reduce the number of triglycerides in the blood.
  • PCSK9 inhibitors: An injectable medication, this type of drug is a relatively new option available to treat people with familial hypercholesterolemia, which causes high levels of LDL cholesterol. PCSK9 inhibitors are also used for anyone who is unable to get their cholesterol levels to goal levels with statins alone, as well as for people with elevated cholesterol levels who cannot tolerate a statin.

In general, these medications are typically only prescribed if you have already had or are at an increased risk for heart attack or stroke, have very high LDL cholesterol levels (190+ mg/dL), or have certain risk factors like diabetes in combination with LDL cholesterol levels above 70 mg/dL. However, only slightly more than half of the individuals who need these medications actually get them.

A Word From Verywell

Hyperlipidemia can significantly increase your chances of having serious heart issues, including heart attack and stroke. While some risk factors (like your genes or family history) are outside of your control, there are many things you can do to lower your cholesterol and triglyceride levels if they are already high.

Because people with hyperlipidemia often don't have any symptoms, it's important to ask your doctor about routine screening and about how often you should be tested based on your current or past health history.

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