From the Guidelines
Secondary dyslipidemias are abnormal lipid levels caused by underlying medical conditions, medications, or lifestyle factors, and include conditions such as diabetes mellitus, hypothyroidism, chronic kidney disease, and certain medications like thiazide diuretics and beta-blockers, as outlined in the 2025 standards of care in diabetes 1. These conditions can lead to elevated triglycerides, low HDL cholesterol, and high LDL cholesterol, increasing the risk of cardiovascular disease.
- Diabetes mellitus can cause elevated triglycerides and low HDL cholesterol
- Hypothyroidism typically raises LDL cholesterol
- Chronic kidney disease disrupts normal lipid metabolism
- Liver diseases like hepatitis and cirrhosis can also affect lipid levels
- Certain medications such as thiazide diuretics, beta-blockers, oral estrogens, glucocorticoids, antiretrovirals, and antipsychotics can contribute to dyslipidemia
- Excessive alcohol consumption can significantly increase triglyceride levels
- Obesity and metabolic syndrome contribute to dyslipidemia through insulin resistance
- Pregnancy can temporarily alter lipid profiles, and rare conditions like Cushing's syndrome and acromegaly also affect lipid metabolism The management of secondary dyslipidemias focuses primarily on treating the underlying condition while also addressing the lipid abnormalities directly if needed, as recommended in the 2025 standards of care in diabetes 1. Understanding the specific cause is crucial because treating only the lipid disorder without addressing the underlying condition will result in suboptimal outcomes and persistent dyslipidemia. According to the 2013 ACC/AHA guideline on the treatment of blood cholesterol, secondary causes of hyperlipidemia include diet, drugs, diseases, and disorders of metabolism, such as nephrotic syndrome, chronic renal failure, and lipodystrophies 1. In individuals with hypertriglyceridemia, lifestyle interventions, treatment of secondary factors, and avoidance of medications that might raise triglycerides are recommended, as stated in the 2025 standards of care in diabetes 1. The 2025 standards of care in diabetes also recommend evaluating for secondary causes of hypertriglyceridemia and considering medical therapy to reduce the risk of pancreatitis in individuals with fasting triglyceride levels ≥500 mg/dL 1. Overall, the management of secondary dyslipidemias requires a comprehensive approach that addresses the underlying cause and the lipid abnormalities, with the goal of reducing cardiovascular risk and improving outcomes, as supported by the 2025 standards of care in diabetes 1.
From the Research
Secondary Dyslipidemias
Secondary dyslipidemias are caused by unhealthy lifestyle factors and acquired medical conditions, including underlying diseases and applied drugs 2. They account for approximately 30-40% of all dyslipidemia 2.
Causes of Secondary Dyslipidemias
Some of the common causes of secondary dyslipidemias include:
- Poorly controlled diabetes mellitus 3, 4, 5
- Hypothyroidism 2, 3, 4
- Hyperfunction of suprarenal glands 3
- Cholestasis 3
- Chronic renal diseases (chronic renal failure, nephrotic syndrome) 3, 5, 6
- Acute infectious diseases 3
- Abuse of alcohol 3, 5
- Certain drugs such as corticosteroids, immunosuppressive drugs, thiazide diuretics, and non-selective beta-blockers 3
- Pregnancy 3
- Cushing's syndrome 4
- Acromegaly 4
- Estrogen therapy 4
Treatment of Secondary Dyslipidemias
Treatment of secondary dyslipidemias should focus on finding and addressing the underlying causative diseases or drugs 2. If causal treatment is possible, hypolipidemic drugs may not be indicated 3. The decision to initiate treatment with hypolipidemic drugs depends on the degree of risk of a fatal cardiovascular event rather than on the blood lipids level 3.