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Secondary causes of dyslipidemia

Author
Robert S Rosenson, MD
Section Editors
Mason W Freeman, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editors
Howard Libman, MD, FACP
Gordon M Saperia, MD, FACC

INTRODUCTION

In many patients, hyperlipidemia is caused by some underlying "nonlipid" etiology rather than a primary disorder of lipid metabolism. The secondary causes of dyslipidemia will be reviewed briefly here (table 1).

Primary lipid disorders are discussed separately. (See "Familial hypercholesterolemia in adults: Overview" and "Inherited disorders of LDL-cholesterol metabolism other than familial hypercholesterolemia" and "Hypertriglyceridemia".)

PREVALENCE

Dyslipidemia due to secondary causes is common. In a cohort of 824 new patients referred to a lipid clinic at an academic medical center in the United States, 28 percent had one or more potential causes of secondary dyslipidemia [1]. The most common conditions that were felt to be contributing to dyslipidemia were excessive alcohol intake (10 percent) and uncontrolled diabetes mellitus (8 percent).

DIABETES MELLITUS

Hyperlipidemia in association with insulin resistance is common in patients with type 2 diabetes mellitus [2,3]. Insulin resistance and the ensuing hyperinsulinemia are associated with hypertriglyceridemia, increased low-density lipoprotein (LDL), and low serum high-density lipoprotein (HDL) cholesterol concentrations. (See "Overview of medical care in adults with diabetes mellitus", section on 'Dyslipidemia'.)

The lipoprotein abnormalities are related to the severity of the insulin resistance. A study that measured insulin sensitivity using a euglycemic clamp in patients with and without type 2 diabetes mellitus found that greater insulin resistance was associated with larger very low-density lipoprotein (VLDL) particle size, smaller LDL particle size, and smaller HDL particle size [4]. Additionally, the number of VLDL, intermediate-density lipoprotein (IDL), and LDL particles increase with increasing insulin resistance, while HDL particle concentration decreases.

          
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Literature review current through: Oct 2017. | This topic last updated: Sep 26, 2017.
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