4. Dyslipidemia - Systemic Disease Fall 2026

What is hyperlipoproteinemia?

High levels of lipoproteins in the blood

What are lipoproteins?

They carry lipids (cholesterol and triglycerides) in the bloodstream

What transports dietary triglycerides?

Chylomicrons

What is VLDL?

Very Low Density Lipoprotein

What is the function of VLDL?

Transport triglycerides synthesized by the liver

What is IDL?

Intermediate Density Lipoproteins

How does IDL relate to VLDL?

VLDL remnant after transporting triglycerides

What is LDL?

Low density lipoprotein; "Bad cholesterol"

What is the function of LDL?

Transports LDL to the cells

What is HDL?

High density lipoprotein; "Good cholesterol"

What is the function of HDL?

Removes excess cholesterol from the body

What are the atherogenic lipoprotein particles?

VLDL, IDL, LDL

**dangerous and can cause lipid deposition in arteries

What is dyslipidemia?

Abnormal amount of lipid in the blood

What are common causes of dyslipidemia?

-High Total Cholesterol

-High LDL

-High Triglycerides

-Low HDL

-Any combo of the above metrics

What is hypercholesterolemia?

High cholesterol levels in the blood, specifically LDL cholesterol

What is hypercholesterolemia a major risk factor for?

development of atherosclerosis

Truck Analogy for Hyperlipoproteinemia, Dyslipidemia, and Hypercholesterolemia (Pic)

Truck Analogy for Hyperlipoproteinemia, Dyslipidemia, and Hypercholesterolemia (Pic)

Dyslipidemia is one of the most important _____ cardiovascular risk factors worldwide

modifiable

____% of adults (>25yo) have elevated cholesterol levels globally

40

1 in ____ adults in the US are on a Statin therapy

5

How does the risk of dyslipidemia relate to age?

Increases with age

What is primary dyslipidemia?

Genetic: Dx at a young age, and fam hx of lipid metabolism conditions

What is secondary dyslipidemia?

D/t underlying disease that affect lipid and lipoprotein metabolism

What are the 3 classifications of primary dyslipidemia?

-Familial hypercholesterolemia

-Familial combined hyperlipidemia

-Familial hypertriglyceridemia

What is Familial hypercholesterolemia?

Autosomal dominant defect in LDL receptor leading to increases LDL in the blood

What is Familial combined hyperlipidemia?

Most common genetic dyslipidemia; leads to elevated LDL, VLDL and triglycerides

What is Familial hypertriglyceridemia?

Excess VLDL; Leads to increased triglycerides and risk of pancreatitis

What are common causes of secondary dyslipidemia?

-Endocrine/Metabolic Causes

-Chronic Kidney Disease

-Excessive Alcohol Use

-Systemic Corticostereoid Therapy

What are endocrine/metabolic causes that lead to secondary dyslipidemia?

DM, Hypothyroidism, Obesity, Metabolic Syndrome

How does Hypothyroidism lead to secondary dyslipidemia?

reducing the number and activity of liver low-density lipoprotein (LDL) receptors; reduced LDL clearance from the blood

How does obesity and metabolic syndrome lead to secondary dyslipidemia?

Obesity and metabolic syndrome lead to secondary dyslipidemia primarily through insulin resistance and the overproduction and impaired clearance of blood fat particles

What are the risk factors for dyslipidemia?

-Genetics

-Obesity

-DM

-Thyroid disease (Hypothyroidism)

-Kidney Disease

-Alcohol

-Corticosteroids

True or False:

A lipid screening is recommended at routine preventative medical care visits

true

At what age should you start screening for dyslipidemia?

>40yo

If risk factors are present, should you start screening for dyslipidemia earlier than 40yo?

Yes

What are the 2 major systemic manifestations of dyslipidemia?

-Atherosclerotic CVD

-Acute pancreatitis

What is the cause of Atherosclerotic CVD?

Elevated atherogenic lipoproteins (LDL)

Can CVD lead to death? How?

CVD --> Coronary Artery Disease --> Cerebrovascular Disease, Carotid Artery Disease, Peripheral Artery Disease --> Heart Attack, Stroke, Death

How does dyslipidemia lead to acute pancreatitis?

Very high levels of triglycerides (>1000mg/dL) and excess chylomicrons

What is the appearance of the blood when levels of triglycerides are >1000mg/dL?

milky blood, lipemic blood

What are the symptoms of acute pancreatitis d/t high levels of triglycerides in the blood?

Severe abdominal pain, N/V

What are the ocular manifestations of dyslipidemia?

-Lipemia Retinalis

-RAO, RVO

-Hollenhorst plaques

-Corneal Arcus

-Xanthelasma

What is Lipemia Retinalis?

a rare eye finding caused by very high levels of triglycerides in the blood (>1000mg/dL)

There is typically a ____ cause to Lipemia Retinalis?

genetic

What is the appearance of the retina with Lipemia Retinalis?

Milky white vessels

How is VA with Lipemia Retinalis?

Typically good

What is the risk with Lipemia Retinalis?

Risk of pancreatitis

What is the treatment for Lipemia Retinalis?

Lower TG levels

Will Lipemia Retinalis likely resolve when TG levels lower?

Yes

True or False:

Patients with dyslipidemia are at risk for RVO and RAO

true

Why are patients with dyslipidemia at risk for RVO and RAO?

d/t atherosclerosis (retinal artery thickening and stiffening)

When retinal arteries thicken/stiffen, how does this lead to a RVO?

Compress vein and lead to turbulent blood flow

How does atherosclerosis lead to a RAO?

Emboli breaks off and then travels to the retina to cause an infarction

What is corneal arcus?

Grey-white ring around the cornea (stroma)

What is the appearance of corneal arcus?

-Separated from the limbus with a clear zone

-Will start at the upper and lower cornea and then form a complete ring

Is arcus visually significant?

No

When is arcus concerning?

In younger patients

Can arcus be removed, reversed or treated?

No

What is xanthelasma?

Yellow deposits in the medial parts of the upper and lower eyelids

What are xanthelasma made of?

Cells that store lipids around the eyelid

Are xanthelasma visually significant?

No

When are xanthelasma concerning?

In younger patients

What is the treatment for xanthelasma?

Surgical excision -- will probably recur

How to diagnose dyslipidemia?

Lipid profile (typically non fasting)

What does a lipid profile entail?

-Total Cholesterol

-Triglyceride

-LDL-C

-HDL-C

-Non-HDL Cholesterol

-Apolipoprotein B (ApoB)

What is Non-HDL Cholesterol?

Total cholesterol minus HDL

What is Apolipoprotein B (ApoB)?

Estimates # of atherogenic lipoprotein particles

What does a fingerstick do to measure dyslipidemia?

Quick measurement of total cholesterol and HDL

Lipid Panel Reference Ranges

Total Cholesterol

< 200 desireable

Lipid Panel Reference Ranges

LDL Cholesterol

<100 Optimal

100-129 Near Optimal

130-159 Borderline

160+ High

Lipid Panel Reference Ranges

HDL Cholesterol

≥40 Men

≥50 Women

Lipid Panel Reference Ranges

Triglycerides

<150 Normal

-150-200 Borderline High

-200-499 High

->500 Very High

Lipid Panel Reference Ranges

Non-HDL Cholesterol

<130 desireable

What are additional labs that can be ordered for patients with dyslipidemia?

-TSH for hypothyroidism

-Glucose/A1C for DM/Insulin resistance

-Liver Function Tests (AST, ALT, ALP, bilirubin)

-Creatin Kinase for Myopathy or Muscle Disorders

What is the physical examination that should be performed on a patient with dyslipidemia?

-Xanthelasma/Arcus?

-Fundus exam

-Auscultation of carotids and femoral arteries

How to incorporate the ASCVD Risk Calculator into Dx of dyslipidemia?

Incorporates multiple modifiable & non-modifiable CV risk factors to estimate an individual's risk (age, sex, hypertension, DM, lipid values, smoking)

What does the ASCVD Risk Calculator calculate the risk of?

Estimates future risk (10 and 30 year) risk of CV complications (such as MI or stroke)

What does the ASCVD Risk Calculator help guide?

preventative therapy decisions

ASCVD Risk Calculator (Pic)

ASCVD Risk Calculator (Pic)

2018 Risk Categories of ASCVD

Low risk Treatments

Lifestyle advice only

2018 Risk Categories of ASCVD

Borderline Risk Treatments

usually lifestyle advise (maybe consider a treatment)

2018 Risk Categories of ASCVD

Intermediate Risk Treatments

Start stain to lower cholesterol

2018 Risk Categories of ASCVD

High Risk Treatments

Needs statin, usually high-intensity

If ASCVD risk is above ____ statin therapy is recommended

7.5%

What is the PREVENT Calculator?

-Replaces the Pooled Cohort Equations for current primary prevention risk assessment

-Incorporates CV-Kidney-Metabolic Health

-Does not include Race

What is the function of the PREVENT Calculator?

Estimates 10 year and 30 year risk of cardiovascular events

PREVENT Calculator (Pic)

PREVENT Calculator (Pic)

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Risk model in 2018

Pooled Cohort Equations (PCE)

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Risk model in 2026

PREVENT-ASCVD

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

2018 10 year risk categories

-Low =

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

2026 10 year risk categories

-Low =

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Race Included in 2018?

Yes

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Race Included in 2026?

No

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Kidney Metabolic Factors in 2018

More limited

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Kidney Metabolic Factors in 2026

Expanded CKM factors

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Long term risk 2018

Primarily a 10yr framework

2018 Guidelines vs 2026 Guidlines for Dyslipidemia

Long term risk 2026

10 and 30 year risk framework

PREVENT 2026 Treatment Guidelines

Low risk (

Lifestyle optimization

PREVENT 2026 Treatment Guidelines

Borderline Risk

Lifestyle optimization (maybe consider treatment)

PREVENT 2026 Treatment Guidelines

Intermediate Risk

Lifestyle optimization + lipid-lowering therapy