Types of Hyperlipidemia and how to manage it

Hyperlipidemia or high cholesterol is a condition where the body has too much cholesterol. There are mainly three types of cholesterol.

LDL is a bad cholesterol and it increases the risk of plague rupture, plague buildup in the arteries, and cardiovascular disease (CVD).

The good cholesterol is HDL. It removes cholesterol from cells before they are deposited as plague in the arteries.

Triglyceride (TG) is the most common type of cholesterol. It stores excessive energy from diet. High levels of TG, together with high level of LDL increases the risk of CVD.

There are several types of medications we can use to lower LDL. Statins is by far the most common type. It reduces LDL by slowing liver production of LDL and increases the liver’s ability to remove them. A new class of injectables have emerged in recent years to provide an alternative for patients who are statin intolerant. The first class I want to highlight is the PCS K9 inhibitors, which is a protein that degrades LDL receptors and increases the LDL absorption from bloodstream into the liver cells. There are two brands, Praluent and Repatha, which are subcutaneously injected once every two weeks. The second class I would like to introduce is Inclisiran which goes by the trade name of LEQVIO. Similarly, it reduces upstream PCS K9 production and increases LDL absorption. The advantage of Inclisiran over Repatha is that patients only need to inject once every six months. Studies have shown that there is a linear relationship between LDL and CVD events, meaning to say the lower the LDL, the better it is for CVD protection. As for patients with established CVD, the lower the LDL, the better.