Lipid Disorders

Overview

Lipids, such as cholesterol and triglycerides, are building blocks for important processes in your body. Cholesterol, for example, is essential to cell membrane and hormone production. But having too much cholesterol increases your risk for heart and vascular disease.

Common lipids include:

• Low-density lipoprotein (LDL) cholesterol — High levels of LDL, known as “bad” cholesterol, contribute to plaque formation (atherosclerosis) along the walls of the arteries.
• High-density lipoprotein (HDL) cholesterol — Also known as “good” cholesterol, HDL helps prevent plaque formation in the arteries and should be kept as high as possible.
• Triglycerides — High levels of triglycerides, or fat in the blood, increases your risk of heart and vascular disease as well as pancreatitis.
• Lipoprotein(a), or Lp(a) — This type of LDL is genetically determined and leads to plaque buildup in the arteries.
• Apolipoprotein B, or ApoB — This protein helps move cholesterol and fat around the body. Testing ApoB levels can help measure your risk for heart disease.

What Causes Lipid Disorders

Many people develop unhealthy levels of certain lipids due to genetics, lifestyle choices or as a result of other health conditions. You are more likely to have a lipid disorder if you have the following risk factors:

• Modifiable risk factors, such as a lack of exercise or a heart-healthy diet
• Type-2 diabetes
• Chronic kidney disease
• Hypothyroidism (underactive thyroid gland)
• Familial hypercholesterolemia or familial hypertriglyceridemia (inherited conditions)
• A family history of lipid disorders

By keeping your lipid disorder under control, you may be able to lower your risk of heart attack, stroke and other complications.

Treatment Options for Lipid Disorders

IU Health specialists work with you and your primary care provider to identify the cause of your lipid disorder and treat even the most challenging and complex cases. It’s possible to move your lipid levels into safer ranges, even if your condition has genetic components or if it fails to respond to medications or has other complicating factors.

Counseling, education and lifestyle changes are always a part of a successful treatment plan, which often includes medications. Many risk factors for lipid disorders can be managed through lifestyle changes. These include:

• Maintaining a heart-healthy diet, which you can begin with the help of a nutritionist
• Completing regular physical activity
• Properly managing chronic conditions, such as diabetes and hypothyroidism

Lipid-Lowering Medication

A variety of medicines can reduce your LDL (“bad”) cholesterol and triglycerides. Oftentimes, a combination of therapies is a safe and effective way to bring lipids into desirable ranges. You may need to take two or more medicines to treat your lipid disorder, such as:

LDL-Lowering Drugs:

• Cholesterol production inhibitors (statins, bempedoic acid)
• Cholesterol absorption inhibitors (ezetimibe, bile acid sequestrants, plant sterols)
• PCSK9 inhibitors (injectable drugs evolocumab, alirocumab, inclisiran)
• Angiopoietin-like protein 3 (ANGPTL3) inhibitor (evinacumab)

Triglyceride Lowering Drugs:

• Statins
• Fibrates
• Omega-3 Fatty Acids

These medicines work in different ways to treat hyperlipidemia.

Clinical Trials

There’s currently extensive research into multiple medications to treat lipid disorders. IU Health offers several opportunities for patients with lipid disorders to benefit from ongoing and cutting-edge clinical trials. One area of study currently underway is investigating therapies to address lipoprotein(a) , which is a genetic risk factor for cardiovascular disease.

Genetic Testing

Many lipid disorders are inherited from parent to child. IU Health offers genetic testing for cardiovascular disorders or inherited cholesterol disorders in specific cases where someone has very high lipid levels or a significant family history. In these cases, genetic testing can often help diagnose a disorder and begin the process of cascade family screening, or systematically screening family members likely to have lipid disorders. Through early diagnosis and treatment, many cardiovascular complications are entirely preventable.