Hyperlipidemia vs. Hypercholesterolemia: What’s the Difference?

• Hyperlipidemia refers to high overall lipid levels, while hypercholesterolemia refers to high LDL and VLDL cholesterol.
• Although there are genetic causes for both conditions, they are both influenced by lifestyle choices.
• Eating the right diet and exercising regularly can lower cholesterol levels and prevent deranged lipid levels.
• A range of medications is available to treat high cholesterol and high lipid levels, including statins and bile acid sequestrants. 

Hyperlipidemia is a medical term that refers to high levels of fats (lipids) in the blood. Those fats can include cholesterol, triglycerides, and high-density lipoproteins (HDL).

Hypercholesterolemia refers to high cholesterol levels only — specifically low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) cholesterol. Although high levels of LDL and VLDL cholesterol can be harmful, cholesterol plays a crucial role in several body functions. High-density lipoprotein (HDL) cholesterol is an incredibly useful compound.

While the two conditions have separate names, hyperlipidemia and hypercholesterolemia share a lot of similarities, including causes, risks, prevention, and treatment.

Understanding more about hyperlipidemia vs. hypercholesterolemia and how each condition works makes it easier to manage your overall health. Both can increase your risk of heart disease and pancreatic conditions, so it’s wise to keep them under control.

A combination of genetics, lifestyle factors, and underlying medical conditions can cause both hyperlipidemia and hypercholesterolemia. Understanding more about each is the best way to manage your risk profile.

Genetic Causes of Hyperlipidemia and Hypercholesterolemia

A number of genetic and lifestyle factors can trigger hyperlipidemia and hypercholesterolemia, including:

• Familial hypercholesterolemia (FH). Individuals who suffer from FH have mutations in the genes that regulate their LDL cholesterol levels. As a result, LDL cholesterol may rise, causing hypercholesterolemia. Around 1 in 200 to 1 in 250 people have this condition in most countries.
• Familial combined hyperlipidemia (FCH). Individuals with FCH suffer from mutations in the genes that regulate cholesterol and triglyceride levels. This condition affects 0.5 to 2 percent of the population.
• Familial hypertriglyceridemia (FHTG). Individuals with FHTG have higher than normal triglyceride levels.
• Apolipoprotein E (ApoE) gene mutations. The ApoE gene is responsible for creating a protein that regulates triglyceride and cholesterol levels. Mutations of the gene make hyperlipidemia more likely.
• Sitosterolemia. Sitosterolemia causes high levels of plant phytosterols (cholesterol-like compounds) in the blood. This condition is rare.

Lifestyle Factors That Cause Hyperlipidemia and Hypercholesterolemia

Certain lifestyle factors, ranging from diet to activity levels, can cause hyperlipidemia and hypercholesterolemia. They include:

• Trans fat consumption. Trans fats increase the amount of LDL cholesterol present in the blood, resulting in high lipid and cholesterol levels.
• Sugar and refined carbohydrates. Eating too much sugar and too many refined carbohydrates raises triglyceride levels. It also makes LDLs become dysfunctional. In their dysfunctional state, LDLs are more likely to clog arteries.
• High-cholesterol foods. Full-fat dairy, egg yolks, and red meat all contain high levels of cholesterol. Eating too much of them can cause hypercholesterolemia.
• Sedentary lifestyle. Increasing physical activity decreases (bad) LDL levels and increases (healthy) HDL levels. It also reduces triglyceride levels, resulting in an overall reduced risk of high cholesterol and lipids.
• Obesity. Being overweight increases LDL cholesterol, and obese individuals usually have higher triglyceride levels.
• Smoking. Smoking may decrease the amount of HDL cholesterol present. As HDL cholesterol helps to absorb overall cholesterol and transport it to the liver for flushing out, having enough is important. One study found that individuals who quit smoking experience an increase in HDL cholesterol, even if they gain weight.
• Alcohol consumption. Heavy alcohol consumption increases the amount of cholesterol and triglycerides present.
• Stress. Stress increases energy consumption. The body responds by making more fuel available to meet demands. Eventually, this causes the liver to release more LDL cholesterol, raising overall cholesterol levels.

Medical Conditions That Cause Hyperlipidemia and Hypercholesterolemia

Several medical conditions can make hyperlipidemia and hypercholesterolemia more likely. They include:

• Diabetes. Diabetes can reduce the amount of HDL present, which then increases LDL and triglycerides.
• Hypothyroidism. When hypothyroidism causes metabolism to slow, it reduces the body’s ability to remove cholesterol and triglycerides.
• Chronic kidney disease (CKD). There’s a reciprocal relationship between having high lipids and CKD. Worsening CKD may also cause higher lipids than normal, as it increases insulin resistance. Insulin resistance increases the production of very low density lipoprotein (VLDL), decreases HDL, and creates smaller dense LDL particles.
• Liver disease. Liver diseases that cause scarring, including alcoholic liver disease, make it harder for the liver to function. One of the liver’s key functions is processing and flushing out bad fats, including triglycerides and LDL cholesterol. As a result, some forms of liver disease can make lipid profiles worse.
• Metabolic syndromes. The term metabolic syndrome describes a group of conditions that can increase the risk of heart disease. Some syndromes make it harder for the body’s enzymes to break down bad fats, including LDL/VLDL cholesterol and triglycerides.
• Autoimmune diseases. Autoimmune diseases, including lupus and rheumatoid arthritis, may increase cholesterol and triglyceride levels.

Medications That Cause Hyperlipidemia and Hypercholesterolemia

Certain medications can cause hyperlipidemia and hypercholesterolemia. Although they may cause either condition, it’s always important to discuss concerns with a doctor rather than stopping them on your own.

Potentially problematic medications include:

• Steroids. Corticosteroids, including prednisolone, may increase blood lipid levels.
• Diuretics. Thiazides, such as hydrochlorothiazide (Microzide) and loop diuretics like bumetanide (Bumex) may increase LDL cholesterol.
• Beta blockers. A very small number of people may experience higher than usual cholesterol levels when taking beta blockers, including propranolol (Inderal).
• Antiretroviral therapy. The antiretroviral therapies used for HIV cause high LDL and triglycerides in many individuals. One recent study found that 77.5 percent of persons taking triple-therapy antivirals developed dyslipidemia.
• Immunosuppressants. Evidence shows that people who take immunosuppressants, including cyclosporine (Gengraf or Neoral), may experience an increase in VLDL, LDL, and triglycerides.
• Birth control pills. Some oral contraceptives, including desogestrel (Apri and many other brand names) may increase lipids.

Complications Associated With Hyperlipidemia and Hypercholesterolemia

When hyperlipidemia and hypercholesterolemia continue uncontrolled, they cause a range of complications.

Those complications can include:

• Atherosclerosis. Atherosclerosis is a condition where the arteries narrow, restricting the flow of blood to the heart, brain, and other organs. Over time, atherosclerosis increases the risk of various cardiac conditions.
• Heart disease. High LDL cholesterol increases the risk of experiencing a heart attack, developing angina, and having heart failure.
• Stroke. When LDL cholesterol remains uncontrolled, it may form blood clots. Eventually, those blood clots may travel through the bloodstream and to the brain to cause a stroke.
• Pancreatitis. High triglyceride levels may eventually cause acute pancreatitis by blocking the pancreatic capillaries. Pancreatitis is a painful condition where the pancreas becomes inflamed.
• Xanthomas. When triglycerides remain uncontrolled, they can cause xanthomas, or lipid deposits on the skin. In some cases, they can build around tendons and reduce mobility.
• Xanthelasmas. Much like xanthomas, xanthelasmas are collections of fat that build up when cholesterol remains uncontrolled. They tend to appear around the eyes.

Preventing Hyperlipidemia and Hypercholesterolemia

Certain lifestyle changes can help to prevent hyperlipidemia and hypercholesterolemia. They include:

• Eating the right diet. Avoiding saturated and trans fats goes a long way toward balancing lipid levels. Also, focusing on fruit, vegetables, and whole grains rather than sugary snacks and carbohydrates helps. One study found that using coconut oil or olive oil instead of butter can lower LDL cholesterol.
• Exercising regularly. Regular exercise raises HDL cholesterol, which lowers LDL cholesterol.
• Weight loss. Losing weight can balance lipids overall, making it important for those with a high body mass index (BMI) to consider weight loss. Evidence suggests that Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets for weight loss can also improve lipid profiles.
• Quitting smoking. Quitting smoking lowers LDL cholesterol and raises HDL cholesterol.
• Reducing alcohol intake. Excessive alcohol prevents the liver from metabolizing lipids. If you’re a moderate to heavy alcohol drinker, consider reducing your intake.
• Regular medical checkups. Regular health screening can identify hypercholesterolemia and hyperlipidemia in the early stages, when they’re easier to manage.
• Managing underlying conditions. Managing underlying health conditions, including diabetes and liver disease, can improve cholesterol and lipid levels.

Diagnosing Hyperlipidemia and Hypercholesterolemia

Doctors use a blood test called a lipid profile to diagnose hyperlipidemia and hypercholesterolemia. Lipid profiles measure total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in the blood.

Your provider will ask you to fast between nine and 12 hours before your blood draw. After examining the results, they may make a diagnosis or order further tests.

Hyperlipidemia and Hypercholesterolemia Treatment

In addition to lifestyle modifications, you may need to use medications to treat your hypercholesterolemia or hyperlipidemia. Medications for these conditions include:

• Statins. Statins such as atorvastatin (Lipitor) and simvastatin (Zocor), lower the amount of LDL cholesterol and triglycerides in your blood.
• Fibrates. Fibrates, such as clofibrate (Merative or Micromedex) and fenofibrate (Tricor), lower triglycerides and increase LDL cholesterol.
• Bile acid sequestrants. Bile acid sequestrants work by binding to bile acids so that the body excretes them rather than the intestine absorbing them. In response, the liver produces more bile acids, and because it needs LDL cholesterol to create them, the end result is less LDL cholesterol. Commonly used bile acid sequestrants include cholestyramine (Questran) and colesevelam (Welchol).
• Niacin. Also known as vitamin B3, niacin increases the production of HDL cholesterol and lowers the production of VLDL cholesterol.
• PCSK9 inhibitors. PCSK9 inhibitors are newer drugs that work by blocking a protein called PCSK9, which decreases LDL. These drugs are usually taken by injection every two to four weeks and include alriocumab (Praluent) and evolocumab (Repatha).

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