Hyperlipidaemia

Abstract

Hyperlipidaemia is characterized by abnormally elevated total cholesterol, triglycerides (triacylglycerols) or both. Hyperlipidaemias can be primary (genetic) or secondary (acquired). Hypercholesterolaemia is a major underlying cause of atherosclerotic cardiovascular disease (ASCVD) and is broadly divided into polygenic and monogenic. Both are associated with increased risk of ASCVD, with lower CVD rates in the former group. The polygenetic group often responds to dietary and lifestyle modification alone, although pharmacological interventions are also used. Monogenic (familial) hypercholesterolaemia always requires pharmacological treatment. Hypertriglyceridaemia is to a lesser degree associated with ASCVD risk. However, the principal clinical concern in hypertriglyceridaemia is increased risk of acute pancreatitis with triglyceride concentrations >10.0 mmol/litre. The primary screening test for hyperlipidaemia is a non-fasting full lipid profile. Serum apolipoproteins (apolipoproteins A1 B, lipoprotein (a)) are used for classifying ASCVD risk. Management includes lifestyle modification, lipid-lowering drugs and treatment of secondary causes, where applicable. Statins are first-line treatment. For primary prevention, 10-year CVD risk assessment is recommended before commencing statins. Patients with a more complex picture have access to new cholesterol-lowering drugs, including proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), inclisiran and bempedoic acid. In hypertriglyceridaemia, management options include lifestyle modifications, fibrates, statins and omega-3 fatty acid.