Is a combination of high Low-Density Lipoprotein (LDL) cholesterol, elevated triglycerides, and low High-Density Lipoprotein (HDL) cholesterol considered dyslipidemia?

Dyslipidemia: High LDL, High Triglycerides, and Low HDL

Yes, the combination of high LDL cholesterol, high triglycerides, and low HDL cholesterol is definitively classified as dyslipidemia and represents a particularly atherogenic lipid profile associated with increased cardiovascular risk.

Definition of Dyslipidemia

Dyslipidemia is a broader term that encompasses any abnormality in lipid metabolism, including:

• Elevated lipid levels
• Decreased lipid levels
• Abnormal composition of lipoproteins 1

The specific pattern of high LDL, high triglycerides, and low HDL is well-recognized as a form of mixed dyslipidemia, which is explicitly mentioned in clinical guidelines and medication indications 2.

Classification of This Specific Lipid Pattern

This particular combination represents:

1. Mixed dyslipidemia - involving abnormalities in multiple lipid parameters simultaneously 2

2. Atherogenic dyslipidemia - a particularly concerning pattern associated with increased cardiovascular risk, especially when accompanied by small, dense LDL particles 3, 4

3. Diabetic dyslipidemia - this pattern is the most common lipid abnormality in patients with type 2 diabetes 3

Risk Assessment and Clinical Significance

According to the American Diabetes Association guidelines, this lipid profile would be categorized as high risk 3:

Risk	LDL cholesterol	HDL cholesterol	Triglyceride
High	≥130 mg/dL	<40 mg/dL	≥400 mg/dL
Borderline	100-129 mg/dL	40-59 mg/dL	150-399 mg/dL
Low	<100 mg/dL	≥60 mg/dL	<150 mg/dL

Note: For women, HDL cholesterol values should be increased by 10 mg/dL 3

Clinical Implications

This lipid pattern is particularly concerning because:

1. Elevated LDL cholesterol is a well-established causal risk factor for atherosclerotic cardiovascular disease 3

2. Elevated triglycerides are independently associated with increased cardiovascular risk, with genetic studies confirming a causal relationship 3

3. Low HDL cholesterol is associated with increased cardiovascular risk, though genetic studies suggest it may not be directly causal when adjusted for other lipid parameters 3

4. Combined effect - When these abnormalities occur together, they create a particularly atherogenic environment that significantly increases cardiovascular risk 3, 5

Special Considerations

• This pattern is commonly seen in:

  • Type 2 diabetes 3
  • Metabolic syndrome 3
  • Obesity 5
  • Insulin resistance states 4

• The presence of small, dense LDL particles (which often accompanies this lipid pattern) further increases atherogenicity even when LDL levels are not markedly elevated 3, 1

• Non-HDL cholesterol (total cholesterol minus HDL cholesterol) becomes an important secondary target for therapy when triglycerides are elevated (≥200 mg/dL) 3

In conclusion, this specific combination of lipid abnormalities represents a well-defined form of dyslipidemia that warrants clinical attention and appropriate management to reduce cardiovascular risk.