Dyslipidemia

Dyslipidemia refers to abnormal blood lipid and lipoprotein concentrations. Dyslipidemia exists when there are elevations in low-density lipoprotein cholesterol (LDL) or triglyceride concentrations or when there is a reduction in high-density lipoprotein cholesterol (HDL). The table below provides the National Cholesterol Education Program (NCEP) blood lipid and lipoprotein classification scheme. Severe forms of dyslipidemia are usually caused by genetic defects in cholesterol metabolism, but marked dyslipidemia can be secondary or caused by another systemic disease. Substantial increases in LDL are often caused by genetic defects related to the hepatic LDL receptor activity but can also be produced by hypothyroidism and the nephritic syndrome. Similarly, some of the highest triglyceride concentrations are produced by insulin resistance and/or DM and marked reductions in HDL are caused by the use of oral anabolic steroids. Dyslipidemia is a major modifiable cause of CVD.

Improvements in cholesterol awareness and more effective treatments primarily using statins or hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors are responsible  for the decline in the prevalence of elevated blood cholesterol levels in recent years. These improvements have contributed to a 30% decline in CVD. Recent clinical trials indicate the added value of cholesterol lowering therapy in high risk individuals, individuals with DM, and older individuals with a treatment goal to lower baseline LDL concentrations by 30%-40%. Current detection, evaluation, and treatment guidelines for dyslipidemia are available in the NCEP Adult Treatment Panel (ATP) III report. The NCEP ATP III report recognizes the importance of lifestyle modification in the treatment of dyslipidemia. These recommendations include increased physical activity and weight reduction if warranted, but expect for the hypertriglyceridemia associated with insulin resistance, most hyperlipidemia requires medication therapy in addition to diet and exercise modification. Nevertheless, exercise is valued for controlling other CVD risk factors and should be a primary component to leading a healthy lifestyle. The ACSM makes the following recommendations regarding exercise testing and training of individuals with dyslipidemia.