Contributor: Dr. Rita Kalyani, MD, MHS
Have you ever been told that you have “bad” or “unhealthy” cholesterol levels? If so, your health care provider might have used the term dyslipidemia to describe your condition. Dyslipidemia covers more than just high levels of “bad” cholesterol (LDL), however. It also describes an excess of triglycerides—components of fats and oils—and lower levels of “good” cholesterol (HDL) in your blood. Over time, dyslipidemia is present in more than half of persons with diabetes. Dyslipidemia is a major risk factor for cardiovascular disease.
What You Need to Know
A person with dyslipidemia has abnormal levels of lipids, such as cholesterol and triglycerides, in the blood.
Cholesterol comes in many forms:
- HDL is known as “good” cholesterol. Women with diabetes should keep their HDL levels above 50 milligrams per deciliter (mg/dL); men above 40 mg/dL.
- LDL is known as “bad” cholesterol. Statin medications in particular can help lower LDL levels and prevent heart disease, stroke, and peripheral vascular disease.
Triglycerides are components of fats and oils:
- High fasting triglyceride levels are commonly considered to be above 150 mg/dL.
- Levels higher than 500 mg/dL at any time of day are considered dangerously high.
Persons with dyslipidemia and type 2 diabetes often have the worst of every category: not enough good cholesterol, too much bad cholesterol, and high levels of triglycerides.
How Is Dyslipidemia Treated?
Treatment always begins with healthy lifestyle changes. If you have dyslipidemia, your health care provider might arrange for you to meet with a dietitian.
In the meantime, follow these simple tips for improving your cholesterol:
- Start by looking at the nutritional facts on your food packaging.
- Reduce saturated and trans unsaturated fat intake and increase omega-3 fatty acids and viscous fiber (such as in oats, legumes, flax, beans, and citrus) in your diet.
- Exercising, losing weight, quitting smoking, and controlling blood glucose levels will help.
- If healthy lifestyle changes aren’t enough, your health care provider might recommend oral medications to improve your lipid levels, such as statins, ezetimibe, niacin, omega-3 fatty acids, fibrates, or bile acid sequestrants. In addition, PCSK9 inhibitors are a relatively newer class of injectable lipid-lowering medications that may sometimes be used to lower LDL levels in persons with a history of heart disease or stroke, in persons who are intolerant to statins, or in combination with statins, if cholesterol goals are not met.
- Generally, all persons with diabetes who are 40 years and older should be on statin medications because they can effectively lower the risk of premature death, heart attack, stroke, and peripheral vascular disease, even among those without dyslipidemia or a history of macrovascular disease. Talk to your health care provider to see if this class of medications might be beneficial for you.
What does it all mean?
Dyslipidemia greatly increases your risk of complications from diabetes, including heart attack, stroke, and peripheral vascular disease, particularly as you get older. Early detection of dyslipidemia through regular cholesterol screenings and statin treatment is essential to preventing complications. Statin medications not only lower LDL cholesterol levels effectively but also prevent heart disease in people with diabetes. Most people with diabetes should be taking a statin medication; talk to your provider to see if one is appropriate for you.
Dr. Rita Kalyani is an Associate Professor of Medicine at Johns Hopkins University School of Medicine in the Division of Endocrinology, Diabetes & Metabolism. She is an active clinician in the Johns Hopkins Comprehensive Diabetes Center. Dr. Kalyani directs the Diabetes Management Service for Johns Hopkins’ Total Pancreatectomy Islet Auto Transplant Program. She is a new member of the DiabetesSisters Board of Directors.
This excerpt is taken from "Diabetes Head to Toe: Everything You Need to Know about Diagnosis, Treatment, and Living with Diabetes" by Dr. Rita Kalyani, Dr. Mark Corriere, Dr. Thomas Donner, and Dr. Michael Quartuccio. Published by Johns Hopkins University Press © 2018. Reprinted by permission of the publisher.