- Dyslipidemia is a condition that occurs when the body’s blood lipids, or fats, are unbalanced.
- The most common type of dyslipidemia is high cholesterol, which is attributable to about 4.4 million deaths every year.
- Recently, the American Heart Association (AHA) and American College of Cardiology (ACC) announced the publishing of updated guidelines for doctors for the management of dyslipidemia.
- The guidelines place an emphasis on earlier intervention through healthy lifestyle choices.
Dyslipidemia is a cardiovascular-related condition that occurs when the body’s blood lipids, or fats, are unbalanced.
The most common type of dyslipidemia is hypercholesterolemia, which is the medical term for high cholesterol. Typically linked to high levels of “bad cholesterol,” low-density lipoprotein cholesterol (LDL-C), researchers estimate that high cholesterol is attributable to about 4.4 million deaths every year.
Past research shows that people with dyslipidemia are at an increased risk for several cardiovascular conditions, including high blood pressure, heart attack, stroke, peripheral artery disease, atherosclerosis, and coronary artery disease.
Dyslipidemia can also heighten a person’s chance of developing type 2 diabetes, pancreatitis, and chronic kidney disease.
Recently, the American Heart Association (AHA) and American College of Cardiology (ACC) announced the publishing of updated guidelines for doctors for the management of dyslipidemia.
The new recommendations — which appear in the journal
Medical News Today spoke with six heart health specialists to find out more about the recommendations and what everyone should know about the updates.
According to Rodrigo Mendirichaga Magana, MD, FACC, FSCAI, interventional cardiologist, director of the Anticoagulation Clinic, and director of cardiac rehabilitation at Wentworth-Douglass Hospital, a Mass General Brigham community hospital, dyslipidemia is the broader term doctors use to describe any abnormality in the lipids, or fats, circulating in the blood.
Magana was not involved in the drafting of the updated guidelines.
“It includes high levels of LDL (the ‘bad’ cholesterol that builds up in artery walls), low levels of HDL (the ‘good’ cholesterol that helps clear that buildup), and elevated triglycerides, which are another type of fat in the blood,” he explained to MNT.
“Why does it matter? Because when these lipids are out of balance, they gradually deposit in the walls of your arteries, forming plaque,” he told us.
“Over time, that plaque narrows the arteries and can rupture, triggering a heart attack or stroke,” he continued. “The problem is that dyslipidemia is largely silent and most people have no symptoms whatsoever until something serious happens.“
“That’s exactly why these guidelines are so important: they help us find and address the problem long before it becomes a crisis,” said Magana.
One of the main focuses of the updated dyslipidemia guidelines is on earlier intervention through healthy lifestyle changes.
“The most powerful tools for protecting your heart are things you can start today with no prescription required,” Magana said.
“The guidelines emphasize five pillars: a
heart-Healthy diet , regular physical activity, avoiding tobacco, quality sleep, and maintaining a Healthy weight. In practice, that means choosing whole foods over ultra-processed ones, aiming for at least 150 minutes of moderate exercise per week, and treating sleep as the Health priority it truly is.”– Rodrigo Mendirichaga Magana, MD, FACC, FSCAI
“The biggest message is that small, consistent habits matter,” added Heather Johnson, MD, director of preventive cardiology for women’s services at Lynn Women’s Health & Wellness Institute, part of Baptist Health South Florida, who was also on the writing committee for the updated guidelines.
“What helps most is making small changes with a focus on a balanced diet, which makes it easier to maintain long term,“ Johnson advised. “Heart risk is shaped by what we do consistently, not just what we do for a week or two. The guideline strongly emphasizes earlier lifestyle-based prevention across the lifespan, not just treatment after disease appears.”
Another recommendation in the updated guidelines is the use of the more contemporary cardiovascular disease risk calculator —
“This matters because cardiovascular disease risk calculators help to guide real-world treatment decisions. The goal is earlier LDL-C reduction for heart disease prevention. PREVENT is a newer tool designed to give a more contemporary estimate of cardiovascular risk. The Dyslipidemia Guidelines encourage its use to help clinicians and patients decide when lifestyle change alone may be enough and when medication should be added sooner.”
– Heather Johnson, MD
For consumers, Johnson said that means a more individualized conversation — not just “What is your cholesterol number?” but “What is your overall risk, and should we act earlier to lower it?”
“The PREVENT equation also offers 10-year and 30-year risk estimates to support heart disease risk discussions in individuals as young as 30 years old,” she added.
Part of the new guidelines calls for the use of three additional tests, when appropriate, to help improve cardiovascular risk assessment and gauge whether or not more intense LDL-C lowering strategies are required.
“A
Lebowitz detailed:
“Lipoprotein(a), or Lp(a), is a one-time blood test that checks for a genetic, ‘sticky’ type of cholesterol that doesn’t improve with lifestyle changes. International guidelines are increasingly recommending this test for all adults. [And]
apolipoprotein B (ApoB) counts all the bad, artery-clogging particles in your blood, giving us a more accurate measure of risk than a standard LDL number alone.”
“These tests provide additional insight into heart disease risk beyond standard cholesterol panels,” added Kevin Shah, MD, a board-certified cardiologist and Program Director of Heart Failure Outreach at MemorialCare Heart & Vascular Institute at Long Beach Medical Center in Long Beach, CA, likewise not involved in the drafting of the updated guidelines.
“For example, a coronary artery calcium scan can directly detect early plaque in the arteries while blood tests including lipoprotein(a) and apolipoprotein B can identify individuals with elevated genetic or particle-related risk. These additional tools can help us counsel patients regarding their long-term risk and what can be done now to lower their risk of heart attack or stroke,” said Shah.
Another area of focus for the updated guidelines are treatment options for a dyslipidemia condition called hypertriglyceridemia.
“Triglycerides are fat in the blood and are made from simple carbohydrates,” Yu-Ming Ni, MD, a board-certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, not involved in the drafting of the updated guidelines, explained to MNT.
“High triglycerides are associated with higher risk for heart disease. We consider high triglycerides to be a risk enhancing factor, so that if some has hypertriglyceridemia, we may be more inclined to be more aggressive in their treatment plan to lower their risk for heart disease,” Ni said.
“Rarely, very high triglycerides indicate a genetic or multifactor acquired condition that makes it hard for the body to process triglycerides, and the risk for pancreatitis becomes elevated,” he continued.
“Because pancreatitis is a dangerous illness to have and can lead to major complications that can be life-threatening, sometimes we will prioritize triglyceride lowering to reduce short term risk for pancreatitis, while still managing the long-term risk for heart disease,” Ni added.
“We have a new class of treatments that significantly reduces triglycerides in these patients, these medicines include olezarsen and
And the updated guidelines also note the fact that high cholesterol can happen earlier in life and impact heart disease risk, especially for children at risk for high cholesterol due to genetics or unhealthy lifestyle habits.
The guidelines recommend cholesterol screening for all children ages 9 to 11 years old.
“This recommendation reflects growing evidence that atherosclerosis begins early in life and that elevated cholesterol in childhood can track into adulthood,” Kaavya Paruchuri, MD, clinical operations director for cardiovascular medicine and director of the Lipid Apheresis Unit at Mass General Health, who was also not involved in the drafting of the updated guidelines, told MNT.
“Universal screening at ages 9–11 helps identify conditions like familial hypercholesterolemia, as well as lifestyle-related lipid abnormalities before symptoms develop,” Paruchuri added.
“Detecting these issues early allows for timely lifestyle changes and, in some cases, medication, which can substantially reduce lifetime cardiovascular risk,” she noted. “In short, it shifts prevention upstream by identifying and addressing risk decades before clinical disease appears.”
