Hyperlipidemia
Hyperlipidemia means cholesterol or triglyceride levels sit higher than recommended for your level of cardiovascular risk. The current 2026 ACC/AHA/Multisociety Dyslipidemia Guideline (replacing the 2018 guideline) uses the PREVENT risk equations for ages 30-79, sorting people into low, borderline, intermediate, and high 10-year risk categories that determine how aggressively to treat.
Symptoms
Almost nobody feels hyperlipidemia. It causes no symptoms in most cases, which is exactly why periodic lipid panels matter -- the first sign is often a cardiovascular event, not a warning. Very high triglycerides (usually over 500 mg/dL) are the exception and can cause abdominal pain or pancreatitis.
Causes and risk
Diet, genetics, diabetes, obesity, low activity, kidney disease, HIV, and some medicines all contribute. A family history of very early heart disease raises the possibility of familial hypercholesterolemia, an inherited condition that is treated more aggressively and can prompt cascade testing of close relatives.
How it is evaluated
We review a full lipid panel alongside family history, blood pressure, blood sugar, and smoking status to calculate 10-year (and sometimes 30-year) cardiovascular risk using the PREVENT equations.
Treatment
Statins are recommended regardless of calculated risk for LDL of 190 mg/dL or higher, and for diabetes, chronic kidney disease, or HIV; they are generally not started for primary prevention when LDL is under 70 mg/dL. Guideline goals target a 30-50% LDL reduction depending on risk, with ezetimibe as the usual first add-on and bempedoic acid as a further option per current FDA labeling. Diet and exercise remain foundational, and the guideline is explicit that fish oil, red yeast rice, garlic, and turmeric are not recommended as substitutes for proven therapy.
When to seek care
High cholesterol itself is not an emergency. But chest discomfort lasting more than about 20 minutes, or any signs of a heart attack or stroke, requires calling 911 -- those are downstream complications reflecting acute coronary syndrome criteria, not warning signs of the lab value itself.