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Hypercholesterolemia is a topic covered in the 5-Minute Clinical Consult.

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  • High cholesterol is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD).
  • Lipoprotein subtypes:
    • Low-density lipoproteins (LDL): atherogenic; primary target of therapy
    • High-density lipoproteins (HDL): atheroprotective
    • Triglycerides (TG)
  • System(s) affected: cardiovascular (CV)


Age: increases with age

27.9% of men and 27.5% of women in the United States with total cholesterol (TC) >240 mg/dL

Etiology and Pathophysiology

  • Pathophysiology
    • Deposition of cholesterol in vascular walls creates fatty streaks which become fibrous plaques.
    • Inflammation causes plaque instability, leading to plaque rupture.
  • Etiology
    • Primary: genetic causes (familial dyslipidemia)
    • Secondary: obesity, diet, excessive alcohol intake, hypothyroidism, diabetes, nephrotic syndrome, liver disease, chronic renal failure, medications (thiazide diuretics, carbamazepine, cyclosporine, progestins, anabolic steroids, corticosteroids, protease inhibitors)

  • Familial hypercholesterolemia (FH)
    • Elevated LDL levels from birth
    • Prevalence = 1:500 in the United States
    • Predisposed to atherosclerotic disease in early adulthood and high coronary heart disease (CHD) risk in 40s to 50s
    • Tendon xanthomas on Achilles and extensor tendons of hands are common.
    • Early lipid-lowering drug therapy shown to reduce ASCVD risk.
  • Early cholesterol testing of first-degree relatives is beneficial.

Risk Factors

Obesity (BMI >30 kg/m2), physical inactivity, heredity, cigarette smoking, excessive alcohol use. Unclear relationship between diet rich in saturated fat and hypercholesterolemia. The relationship of diet to disease is very complex and is not explained by how much cholesterol is present in an individual’s diet. Eggs and whole fat dairy sources are likely not significant contributors to atherosclerosis.

General Prevention

  • Regular physical activity
  • Weight control (see “Ongoing Care”)

Commonly Associated Conditions

Hypertension, diabetes mellitus (DM), obesity

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Stephens, Mark B., et al., editors. "Hypercholesterolemia." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116292/all/Hypercholesterolemia.
Hypercholesterolemia. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116292/all/Hypercholesterolemia. Accessed April 25, 2019.
Hypercholesterolemia. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116292/all/Hypercholesterolemia
Hypercholesterolemia [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116292/all/Hypercholesterolemia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hypercholesterolemia ID - 116292 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116292/all/Hypercholesterolemia PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -