Hyperlipidemia refers to a condition where one or more plasma lipids are abnormally elevated due to disorders in fat metabolism or transport. Since lipids are insoluble or barely soluble in water, they must bind to proteins and exist in the form of lipoproteins. Therefore, hyperlipidemia is often synonymous with hyperlipoproteinemia. It manifests as hypercholesterolemia, hypertriglyceridemia, or both, and is clinically classified into two categories:

1. Primary, which is rare and involves inherited lipid metabolism disorders;
2. Secondary, commonly seen in poorly controlled diabetes, alcohol consumption, hypothyroidism, nephrotic syndrome, renal dialysis, kidney transplantation, biliary obstruction, oral contraceptive use, etc.

1. Chylomicrons (CM)
2. Very-low-density lipoprotein (VLDL)
3. Low-density lipoprotein (LDL)
4. High-density lipoprotein (HDL)

bubble_chart Auxiliary Examination

1. Blood lipids, plasma total cholesterol<5.2mmol/L是理想水平；5.2～6.2mmol/L為臨界；≧6.2mmol/L為過高。血漿甘油三酯<1.7mmol/L為理想；1.7～2.3mmol/L為臨界；>2.3mmol/L is considered too high.
2. Lipoproteins, measuring LDL and HDL is more meaningful than total cholesterol. Elevated LDL levels are associated with an increased prevalence and mortality of cardiovascular diseases, while elevated HDL levels help prevent the occurrence of atherosclerosis.

bubble_chart Diagnosis

1. Medical history and symptoms: Primary cases are seen in children, while secondary cases mostly occur after the age of 20. Most individuals are asymptomatic and only discovered during physical examinations. Early-onset coronary heart disease and other atherosclerosis-related conditions such as apoplexy and peripheral vascular disease may also occur. It is often accompanied by obesity, impaired glucose tolerance (or diabetes), hyperinsulinemia, and hyperuricemia, and acute pancreatitis may develop. Xanthomas often appear on the upper or lower eyelids or as tendon xanthomas on the extensor tendons of the limbs, such as the olecranon, patella, or heel, with pain and tenderness when associated with tendinitis.
2. Physical examination findings: Signs may include obesity, peripheral neuritis, or atherosclerosis-related conditions and diabetes.

bubble_chart Treatment Measures

Long-term comprehensive treatment should be adhered to, emphasizing dietary control and physical exercise as the primary approach, with medication considered only if the effects are unsatisfactory. For secondary cases (such as diabetes or hypothyroidism), the underlying disease should be actively treated.

1. Diet and exercise therapy: The goal is to reduce plasma cholesterol and maintain balanced nutrition. Exercise and weight loss not only help lower cholesterol but also reduce triglycerides and hypertension while increasing HDL cholesterol.
2. Medication: If one of the following conditions persists after dietary and exercise therapy, medication should be considered: (1) No other risk factors, LDL cholesterol ≥4.9mmol/L (190mg/dl); (2) Two risk factors (e.g., smoking, hypertension, low HDL cholesterol, family history of early-onset coronary heart disease, etc.), LDL cholesterol ≥4.1mmol/L (160mg/dl); (3) Triglycerides ≥5.5mmol/L (500mg/dl). For men under 35 or premenopausal women with no other risk factors, medication may be temporarily deferred. The main lipid-lowering drugs include:
   1. Bile acid sequestrants such as cholestyramine, taken orally at 4–5g per dose, three times daily, or colestipol, taken at 4–5g per dose, three times daily. Regular blood tests, liver function, and electrolyte monitoring are recommended during treatment.
   2. Nicotinic acid (niacin) is used to treat combined hypercholesterolemia and hypertriglyceridemia. Start with 0.1g three times daily, then adjust to 1–2g three times daily based on lipid changes and tolerance. Side effects include skin flushing, cutaneous pruritus, stomach discomfort, indigestion, elevated blood sugar, hematuria, increased uric acid, peptic ulcer, etc. Long-term use requires monitoring of liver function. Acipimox is taken at 250–500mg before bedtime, with an additional 250mg at breakfast if needed.
   3. Fibrates, such as clofibrate, taken orally at 0.5g per dose, three times daily.

AD

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bubble_chart Differentiation

It should be differentiated from secondary hyperlipoproteinemia caused by dietary factors, diabetes, hypothyroidism, kidney disease, biliary obstruction, and gallstone cirrhosis.