A lipid disorder means abnormal blood fats, most often high LDL cholesterol, high triglycerides or low HDL, which speeds up plaque buildup in the arteries. It usually causes no symptoms until a heart attack or stroke, so screening and risk-based treatment are key.
Key symptoms
- Usually no symptoms
- Chest pain, leg pain on walking or stroke signs from advanced plaque
- Abdominal pain from pancreatitis when triglycerides are very high
- Family history of early heart disease
What you find on exam
- Blood pressure, weight, BMI and waist size
- Tendon xanthomas or xanthelasma around the eyes
- Corneal arcus at a young age
- Pulses and bruits for vascular disease
Tests
- Lipid panel, fasting or nonfasting
- 10-year cardiovascular risk score
- Glucose or HbA1c, TSH, liver and kidney function
- Lipoprotein(a) once in adulthood; coronary calcium score if the decision is unclear
Treatment basics
- Heart-healthy diet, exercise, weight loss and no smoking
- Statin such as atorvastatin, with intensity matched to risk
- High-intensity statin for known vascular disease or LDL of 190 mg/dL or more
- Add ezetimibe or a PCSK9 inhibitor if LDL stays above goal
- Very high triglycerides: treat causes, then a fibrate or icosapent ethyl
Red flags
- LDL of 190 mg/dL or more, which suggests familial hypercholesterolemia
- Triglycerides over 1000 mg/dL with abdominal pain
- Muscle pain with dark urine while on a statin
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.