Hyperlipidemia

Overview:

    • Hyperlipidemia refers to an elevation of triglycerides, high-density lipoproteins (HDL), total cholesterol (TC) or low-density lipids (LDL). Hyperlipidemia can stem from genetic mutations, diet or environmental factors. With prolonged elevation, it can lead to blood clots that cause heart attacks or strokes.

    • Hyperlipidemia can occur in any individual. Currently, in the United States an estimated 73 million adults or roughly 1/3rd of the population that suffer from hyperlipidemia. People with high cholesterol have about twice the risk of developing heart disease compared to patients with normal levels.

    • Hyperlipidemia is often broken into different classifications. Atherosclerosis is when plaque builds up in your arteries. Atherosclerosis classification is dependent upon the location of arterial involvement is categorized as one of the following: Coronary Heart Disease (heart), Carotid Artery Disease (neck), Peripheral Artery Disease (legs, arms, pelvis). Heterozygous Familial Hyperlipidemia (HeFH) is when a person has an abnormal copy of one LDL-receptor gene. Homozygous Familial Hyperlipidemia (HoFH) is when a person has abnormal copy of two LDL-receptor genes.

Symptoms:

    • Hyperlipidemia is commonly a symptomless disease. In some patients though, it can have physical manifestations such as yellowish patches underneath the skin and around the eyelids, white or gray discoloration of the cornea or xanthomas (nodules on the tendons of the hands, feet and heel).

Treatment:

    • There are various ways to manage hyperlipidemia. First line therapy is for individuals to manage their cholesterol through changes in diet and exercise.

    • If reduction is unsuccessful following lifestyle modifications,a medication regimen is then initiated. The initial medication regimen is a high intensity statin with Zetia for 3 months to manage their hyperlipidemia. If that fails to cause reduction, then an addition of a PCSK9 injection such as Praluent or Repatha is recommended. In the case of HoFH, Juxtapid or Kynamro may be used.

Medications:

    • Apolipoprotein B Antisense Oligonucleotide
    • Microsomal Triglyceride Transfer Protein (MTP) Inhibitor

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