Difference Between Hypercholesterolemia and Hyperlipidemia
Hypercholesterolemia is a specific type of hyperlipidemia—hyperlipidemia is the broader umbrella term referring to any elevation in blood lipids (cholesterol, triglycerides, or both), while hypercholesterolemia specifically refers to elevated cholesterol levels only. 1
Key Definitional Distinctions
Hyperlipidemia encompasses the full spectrum of lipid abnormalities, including:
- Elevated total cholesterol 1
- Elevated LDL cholesterol 1
- Elevated triglycerides 1
- Decreased HDL cholesterol 1
- Any combination of these abnormalities 1
Hypercholesterolemia is more narrowly defined as:
- Specifically elevated cholesterol levels (total cholesterol and/or LDL cholesterol) 2
- Does not necessarily involve triglyceride abnormalities 3
- Can be isolated (pure hypercholesterolemia, Type IIa) with normal triglycerides 4
Clinical Classification Framework
Hyperlipidemia Subtypes
Pure hypercholesterolemia (Type IIa):
- Elevated LDL cholesterol only 4
- Normal triglycerides 4
- This is what clinicians typically mean by "hypercholesterolemia" 4
Mixed hyperlipidemia (Type IIb):
- Elevated both cholesterol AND triglycerides 4
- This falls under hyperlipidemia but NOT pure hypercholesterolemia 4
- Familial combined hyperlipidemia (FCHL) presents this pattern with combined elevation of LDL cholesterol, VLDL, and triglycerides 1
Pure hypertriglyceridemia (Type IV):
- Elevated triglycerides with normal cholesterol 1
- This is hyperlipidemia but NOT hypercholesterolemia 1
- Triglycerides typically 200-1000 mg/dL with elevated VLDL 1
Practical Clinical Implications
When evaluating lipid panels, the distinction matters for:
Cardiovascular risk stratification: Elevations in total cholesterol, LDL cholesterol, and non-HDL cholesterol are associated with cardiovascular disease risk in adults, as are lower HDL cholesterol levels and, to a lesser extent, elevated triglyceride levels 2
Treatment selection: Pure hypercholesterolemia responds primarily to statins and cholesterol absorption inhibitors, while mixed hyperlipidemia or hypertriglyceridemia may require fibrates or other triglyceride-lowering agents 2, 5
Genetic diagnosis: Familial hypercholesterolemia is characterized by highly elevated LDL cholesterol levels (≥190 mg/dL), genetic mutation, or both, without necessarily involving triglyceride abnormalities 2, 6
Common Clinical Pitfall
The term "dyslipidemia" is often used interchangeably with hyperlipidemia, but technically dyslipidemia is even broader—it refers to any lipid abnormality affecting plasma lipoprotein function and/or levels, including situations where lipid levels may be normal but lipoprotein composition is abnormal. 1 For example, metabolic syndrome-associated dyslipidemia can present with normal total cholesterol but abnormal lipoprotein composition 1.
Diagnostic Approach
When encountering elevated lipids:
- If only cholesterol is elevated: This is hypercholesterolemia (and also hyperlipidemia) 2, 4
- If only triglycerides are elevated: This is hyperlipidemia but NOT hypercholesterolemia 1
- If both are elevated: This is mixed hyperlipidemia (not pure hypercholesterolemia) 4
Multifactorial dyslipidemia is defined by elevations in LDL cholesterol (≥130 mg/dL) or total cholesterol (≥200 mg/dL) not attributable to familial hypercholesterolemia, and is strongly associated with obesity. 2, 1 Obesity causes slight LDL cholesterol elevation but more pronounced triglyceride elevation and HDL cholesterol reduction 2, 1, which would technically be mixed hyperlipidemia rather than pure hypercholesterolemia.