HLP — the plain-language one-pager.

What is Hyperlipidemia?Diagnosis

Hyperlipidemia means high levels of cholesterol or triglycerides in your blood. The most important number is your LDL ("bad") cholesterol — when LDL is high, it gets pulled into the artery wall, triggers inflammation, and starts the atherosclerosis cascade that ends in heart attack, stroke, and peripheral artery disease decades later. The good news: LDL is one of the most modifiable cardiovascular risk factors in medicine. Even modest reductions cut events significantly, and modern therapy can drop LDL by 50–80%.

• Know your numbers — A standard lipid panel reports Total cholesterol, LDL, HDL, Triglycerides. Beyond that, ask your team about ApoB (the truer count of all atherogenic particles) and Lp(a) (a genetic, lifelong cardiovascular risk factor — check it once in your life if you have not).
• LDL targets vary by risk — General prevention: <100 mg/dL. With diabetes or other risk factors: <70 mg/dL. After a heart attack, stroke, or known ASCVD: <55 mg/dL is increasingly the standard. Lower really is better — there is no LDL "too low" in modern lipidology.
• Familial Hypercholesterolemia (FH) — Roughly 1 in 250 people inherit very high LDL from birth. Untreated FH causes early heart attacks (men in their 40s, women in their 50s). Cascade family screening saves lives.
• Modern toolbox — Statin (high-intensity atorvastatin or rosuvastatin first line), ezetimibe add-on, PCSK9 inhibitor (alirocumab/evolocumab — twice-monthly injection, drops LDL ~60%), bempedoic acid (statin alternative), inclisiran (twice-yearly injection). Statin intolerance is real but rarely means you can take nothing.

Statin intolerance is not the end of the roadKnow your plan

Up to 1 in 4 patients reports muscle aches on a statin. Real statin myopathy is far less common — but real or perceived intolerance still ends treatment for too many people. The modern playbook keeps your LDL low, statin or no statin.

• Try at least 2-3 different statins at the lowest tolerated dose. Side effects are statin-specific, not class-wide.
• Add ezetimibe. Cheap, generic, drops LDL another ~20% on top of any statin or alone.
• PCSK9 inhibitors (Repatha, Praluent) — injection every 2 weeks. Drops LDL by ~60%. Approved for FH, ASCVD, and statin intolerance.
• Bempedoic acid — pill, statin-alternative, no muscle effect. Drops LDL ~20%.
• Inclisiran — injection twice a year. Big LDL drop, low maintenance.

Your daily Force FieldLive It

• Take your lipid-lowering therapy every day — the LDL drop comes from consistency, not perfection.
• Heart-healthy eating — Mediterranean or DASH pattern. Less ultra-processed food, less saturated fat, less added sugar. Olive oil, fish, nuts, vegetables, whole grains.
• 150 minutes/week moderate activity — improves HDL, drops triglycerides, drops weight, drops BP, drops insulin resistance — all at once.
• No tobacco — smoking turns LDL more atherogenic and damages the endothelium directly.
• Annual lipid panel + ApoB — once at goal, your team will time follow-up. After any med change: 6–12 weeks.
• Once-in-life Lp(a) — if not yet checked, ask. Elevated Lp(a) changes the prevention plan and triggers family screening.
• Family cascade screening for FH — if anyone in your family had a heart attack before 55 (men) or 65 (women), or had very high cholesterol, screen first-degree relatives.

Red flags — call nowAction

• Call your clinic the same day for: new chest discomfort with exertion that goes away with rest (stable angina worth evaluating); a missed dose of antiplatelet or statin; medication side effects (muscle aches, bleeding, GI symptoms).
• Bring up at next visit: any change in exercise tolerance, lipid follow-up timing, BP log review, smoking-cessation support, depression screening, sleep concerns.