Hyperlipidaemia

Hyperlipidaemia includes hypercholesterolaemia, hypertriglyceridaemia and mixed hyperlipidaemia. It is a common biochemical disorder with primary (inherited) and secondary causes. All patients should be investigated for possible secondary causes. Hypercholesterolaemia is commonly polygenetically inherited, whereas familial hypercholesterolaemia is monogenic and has a high risk of cardiovascular disease (CVD). Evidence of CVD risk in hypertriglyceridaemia is weaker than in hypercholesterolaemia, but concentrations >10.0 mmol/litre are associated with a high risk of acute pancreatitis. The primary screening test is serum fasting full lipid profile. Serum apolipoproteins (Apo-A1, Apo-B), lipoprotein (a) and highly sensitive C-reactive protein can be useful in patients with unusual or borderline CVD risk. Management includes treating secondary causes and optimizing modifiable risk factors including lifestyle. Assessing 10-year CVD risk is always recommended before starting treatment in primary prevention, whereas treatment is always indicated in patients with established CVD risk. Statins are the first-line treatment in hypercholesterolaemia; the treatment target depends on the individual's CVD risk. In hypertriglyceridaemia, statins are first-line therapy for a concentration <6.0 mmol/litre, but fibrates and/or high-dose fish oils should be considered for concentrations >6.0 mmol/litre. Hypertriglyceridaemia >10.0 mmol/litre indicates fibrates and a very low-fat diet. A statin-fibrate combination can be used in mixed hyperlipidaemia.