Dyslipidemia Management

What Is Dyslipidemia Management

Dyslipidemia is an abnormal level of fats in the blood, mainly high LDL cholesterol, high triglycerides, or low HDL cholesterol. This condition usually causes no symptoms, but high LDL over a long period builds up in the walls of blood vessels as plaque and raises the risk of heart attack and stroke. Dyslipidemia management is long-term treatment to lower your blood fat levels to a target that matches your risk level.

How It Works at a Glance

The lower your LDL cholesterol and the longer it is kept low, the lower your risk of heart attack and stroke. A combined analysis of many studies shows that every reduction in LDL of about 39 mg/dL lowers major cardiovascular events by roughly one fifth. Statins block cholesterol production in the liver, so the liver pulls more LDL out of the blood, while add-on medicines strengthen this effect in different ways.

Targets by Risk Level

Your doctor assesses your risk level beforehand, then sets your LDL cholesterol target. This is covered on the Individual Heart Risk Screening page.

• Low risk: LDL below 116 mg/dL.
• Moderate risk: LDL below 100 mg/dL.
• High risk: LDL below 70 mg/dL and reduced by half or more from the starting value.
• Very high risk: LDL below 55 mg/dL and reduced by half or more, for example after a heart attack or stroke.

Treatment Steps

• Diet and lifestyle: limit saturated and trans fats, eat more fiber, stay active, maintain a healthy weight, stop smoking, and cut down on alcohol if your triglycerides are high. This is covered on the Lifestyle Counseling and Risk Management page.
• Statins: the main LDL-lowering medicines, with the dose adjusted to your target.
• Add-on medicines: ezetimibe if the target has not been reached, then PCSK9 inhibitor injections for very high risk or inherited high cholesterol. Bempedoic acid is an option for people who cannot take statins. This is covered on the Integrated Medication Therapy page.
• High triglycerides: managed by improving blood sugar, weight, and drinking habits, then with medicines if needed. Very high triglycerides, for example above 880 mg/dL, can trigger inflammation of the pancreas (pancreatitis) and need prompt treatment.
• Inherited high cholesterol: LDL of 190 mg/dL or higher may indicate familial hypercholesterolemia; close family members should also be tested.
• High Lp(a): its level is determined by genetics and no specific medicine is widely available yet, so other risk factors are controlled more strictly.

Monitoring

Your lipid profile is rechecked 4 to 12 weeks after a medicine is started or changed, then about once a year once the target is reached. This is covered on the Cholesterol and Lipid Profile Screening page. Liver function is usually checked before and a few weeks after starting a statin, while creatine kinase is checked if muscle symptoms appear. These are covered on the Liver Function Test and Creatine Kinase (CK) Test pages.

There is no recovery period for a consultation. The key is to follow your treatment plan consistently.

Take your medicine every day. Cholesterol rises again if the medicine is stopped, so do not stop it on your own even when your results look good.

Diet. Replace saturated fats, such as thick coconut milk, fried foods, and fatty meat, with unsaturated fats from fish, nuts, and vegetable oils; eat more vegetables, fruit, and whole grains.

Stay active. Aim for 150 minutes or more of moderate-intensity physical activity per week.

Report symptoms. Tell your doctor if you have unusual muscle pain or weakness, dark urine, or yellowing of the skin and eyes.

Warning signs. Go to the emergency room right away if you have:

• Chest pain, shortness of breath, or cold sweats that do not go away
• Sudden facial drooping, arm weakness, or slurred speech
• Severe upper abdominal pain spreading to the back, especially if your triglycerides are very high