What Is a Lipidologist?

This specialty is dedicated to cholesterol and blood fats

In This Article

An illustration depicting atherosclerosis.
Science Picture Co/Getty Images

Lipidologists are physicians who diagnose, manage, and treat disorders involving lipids, which include cholesterol and triglycerides. It is a relatively new profession whose organizing body, the American Board of Clinical Lipidology (ABCL), only began offering certification in 2009. As of 2015, only 625 lipidologists were certified in the United States.

Despite its relative newness, lipidology is considered an increasing relevant specialty. Today, nearly one-third of Americans over age 20 have high cholesterol, a risk factor for both heart attacks and stroke.

With the cost of treating cardiovascular diseases expected to double by 2030, according to the American Heart Association, a greater impetus may be placed on establishing practices solely dedicated to the diagnosis and treatment of dyslipidemia (lipid disorders).

Concentrations

The core function of a lipidologist to treat or prevent dyslipidemia, a condition characterized by high levels of "bad" low-density lipoprotein (LDL) cholesterol and triglycerides as well as low levels of "good" high-density lipoprotein (HDL) cholesterol. Studies have long shown a direct association between dyslipidemia and the development of atherosclerosis (hardening of the arteries), coronary artery disease, peripheral artery disease, heart attack, and stroke.

With that being said, the cardiovascular system is not the sole concern of a lipidologist. Dyslipidemia can affect other organ systems, contributing to the development or severity of chronic kidney disease, diabetes, and liver cirrhosis (or vice versa).

Procedural Expertise

Since most people will be referred to a lipidologist after dyslipidemia has been diagnosed, the specialist's work will be mainly focused on identifying the underlying cause. Once that is determined, he or she will help devise a treatment plan, which typically involves lifestyle changes (including exercise, weight loss, and reduced saturated fats) and various lipid-lowering drugs, if needed.

Diagnosis

The lipidologist will typically start by ascertaining the type of dyslipidemia you have, broadly described as follows:

  • Primary dyslipidemia is characterized by genetic mutations that cause your body to produce too much LDL or triglycerides or not enough HDL. Examples include familial hypercholesterolemia (high total cholesterol), familial hypertriglyceridemia (high triglycerides), and hypoalphalipoproteinemia (low HDL).
  • Secondary dyslipidemia is caused by lifestyle factors (such as obesity, alcoholism, or a diet high in saturated fat) or co-occurring conditions (such as diabetes, hypothyroidism, metabolic syndrome, chronic kidney disease, or cirrhosis).

In some cases, primary dyslipidemia may be compounded by secondary dyslipidemia.

Testing

A lipidologist is skilled in advanced cholesterol testing. Standard cholesterol tests only identify total cholesterol, HDL, LDL, and triglycerides. Advanced tests can detect multiple cholesterol subclasses and provide 13 qualitative measurements of cardiovascular disease risk.

This includes the size and quantities of cholesterol and triglycerides, as well as the identification of an LDL subtype called apolipoprotein B100 linked to familial hypercholesterolemia. By identifying the underlying mechanism of dyslipidemia, the lipidologist may be able to render a more tailored response to treatment.

On top of blood testing, the lipidologist may recommend magnetic resonance imaging (MRI) to evaluate the amount of fat in muscle tissues. Research suggests that high intramuscular fat is independently associated with high total cholesterol as well as impaired glucose tolerance (a predictor of type 2 diabetes).

The management of cholesterol has long been considered a facet of primary care. But, as more and more people find themselves unable to control their cholesterol, lipidologists are increasingly being sought to find new solutions for this hard-to-treat population. This includes people who have become resistant to statin drugs or are unable to tolerate the side effects.


Treatment

Once the condition is diagnosed, the treatment plan would typically involve lifestyle changes (including exercise, weight loss, and reduced saturated fats) and various lipid-lowering drugs, if needed.

Some people, including those with severe familial cholesterolemia, are unable to sufficiently lower their LDL with statin drugs. Others may be unable to tolerate the side effects. Others still may be treated for primary dyslipidemia even though the cause may be genetic.

Because lipidologists understand the dynamics of dyslipidemia, they may be better equipped to prescribed treatments able to overcome these obstacles. Among some of the more specialized treatments currently available:

  • PCSK9 inhibitors are a class of drug that blocks proteins that prevent the clearance of LDL in the liver. Praluent (alirocumab) and Repatha (evolocumab) are two PCSK9 inhibitors approved by the U.S. Food and Drug Administration (FDA).
  • LDL apheresis is a nonsurgical procedure similar to hemodialysis that removes LDL from blood.
  • Juxtapid (lomitapide) is a drug specifically approved for the treatment of familial hypercholesterolemia.
  • Mipomersen sodium is an investigational drug that inhibits the formation of apoprotein B100.

In rare cases, surgical procedures such as partial ileal bypass surgery, liver transplantation, or liver portocaval shunting may be used to treat conditions associated with dyslipidemia.

Beyond medications, lipidologists oversee dietary and exercise interventions, particularly for those at high risk of cardiovascular disease. This generally involves a monitored diet of which only 7 percent to 10 percent of the total daily calories would be fat.

Aerobic exercise, stress management training, smoking cessation, and psychosocial support may also be a part of the intensive treatment program.

Training and Certification

There are two types of certification programs in clinical lipidology. One is offered through the ABCL and is intended for physicians only. The other is available to both physicians allied health professionals through the Accreditation Council for Clinical Lipidology (ACCL).

Physicians who pass the ABCL board exam are certified for a period of 10 years. There are no letters to designate the ABCL accreditation. Instead, practitioners can include the title "Diplomate, American Board of Clinical Lipidology (ABCL)" in their professional designation.

Only those who meet ABCL eligibility and pass the board exam can call themselves lipidologists. Those who pass the ACCL exam are called "clinical lipid specialists" and can add the letters CLS after their names.

Appointment Tips

People are usually referred to a lipidologist when their LDL-lowering drugs fail. According to guidance from the American Heart Association and the American College of Cardiology, a lipidologist may be sought if treatment under a primary care physician fails to improve cholesterol levels after 12 weeks.

If you are scheduled to meet with a lipidologist, ask your primary care doctor to forward all relevant medical records in advance of your appointment. You should also compile a list of the medications you take, both pharmaceutical and non-pharmaceutical, as well as any medical conditions for which you have received treatment.

Before your appointment, check that the visit and subsequent tests and treatments are covered by your health insurance. It is rare that you visit a lipidologist only once. If the office does not accept your insurance, ask if they offer a scheduled payment plan or a reduced upfront cash payment.

The lipidologist will want to know if you have a family history of dyslipidemia, diabetes, cardiovascular disease, kidney disease, or thyroid disease. When asked about drinking or smoking, be honest and don't say that you drink or smoke less than you actually do. The same applies to diet, exercise, and chronic drug adherence.

When meeting with a lipidologist, ask as many questions as needed to fully understand:

  • What tests are involved
  • How the tests are performed
  • What the test results mean and don't mean
  • What lifestyle factors may be placing you at risk
  • What treatment options are available
  • Which complementary therapies are safe to use
  • What the various tests and treatments cost

Be sure to ask that your results be shared with your primary care doctor and other relevant specialists.

To find a certified lipidologist near you (or to check their credentials), call the American Board of Clinical Lipidologists at (904) 674-0752.

A Word From Verywell

Not everyone with high cholesterol needs a lipidologist. In fact, most people with dyslipidemia can manage perfectly well under the care of a primary care physician as long as they are not at high risk of cardiovascular disease. If the risk is especially high, a cardiologist may be the more appropriate specialist to see.

Lipidologists are most useful for people who fail to respond to standard medications and have taken all other steps to control their condition. A lipidologist is not there to prescribe "stronger" drugs so that you can sidestep diet or exercise. If anything, a lipidologist will actively address lifestyle choices that are putting your health at risk.

Was this page helpful?

Article Sources