Is Hyperlipidemia Considered Cardiovascular Disease?
No, hyperlipidemia is not cardiovascular disease itself—it is a major risk factor and marker for developing cardiovascular disease, not the disease itself. 1
Key Distinction: Risk Factor vs. Disease
Hyperlipidemia functions as a modifiable risk factor that substantially increases the probability of developing actual cardiovascular disease (such as coronary heart disease, myocardial infarction, or stroke), but it does not constitute the disease entity itself. 1, 2
The Endocrine Society explicitly states that hypertriglyceridemia "should be considered a marker for risk in some patients" rather than cardiovascular disease itself, noting that "it is unclear whether hypertriglyceridemia causes atherosclerosis; an elevated triglyceride level may, in some cases, be a marker for cardiovascular disease rather than a causal factor." 1
The European Society of Cardiology guidelines classify elevated triglycerides and hypercholesterolemia as "significant independent CVD risk factors," clearly distinguishing them from actual cardiovascular disease endpoints. 1
Clinical Classification Framework
Hyperlipidemia belongs to the category of cardiovascular risk factors, alongside hypertension, smoking, and diabetes—not to the category of cardiovascular diseases like coronary artery disease, myocardial infarction, or stroke. 1
The World Heart and Stroke Forum guidelines state that "a strong, independent relationship exists between serum LDL cholesterol levels and risk for CHD," emphasizing the risk relationship rather than disease equivalence. 1
Research confirms that "hyperlipidemia represents a determinant for the development of atherosclerosis and an important risk factor for cardiovascular disease," clearly positioning it as a precursor rather than the disease itself. 3
Strength of Association
While not the disease itself, hyperlipidemia carries profound prognostic significance:
Patients with hyperlipidemia face approximately twice the risk of developing cardiovascular disease compared to those with normal cholesterol levels. 2
LDL cholesterol demonstrates a "strong, independent relationship" with coronary heart disease risk, with this relationship being continuous—meaning risk increases progressively as LDL levels rise. 1
The European guidelines note that hypertriglyceridemia is "a significant independent CVD risk factor, but it seems that the association is not as strong as for hypercholesterolaemia." 1
Special Consideration: Familial Hypercholesterolemia
Patients with familial hypercholesterolemia represent a unique situation where the risk is so dramatically elevated that they develop "aggressive premature atherosclerosis and suffer early coronary morbidity and mortality," requiring treatment "regardless of the presence of other cardiovascular risk factors." 1
- Even in these high-risk genetic conditions, the hyperlipidemia itself remains the risk factor, while the actual cardiovascular disease develops as a consequence. 2
Practical Clinical Implications
This distinction matters for documentation, treatment decisions, and patient communication:
Treatment of hyperlipidemia aims to prevent cardiovascular disease from developing, not to treat existing cardiovascular disease (though it also reduces recurrent events in those with established disease). 1
Risk stratification tools incorporate hyperlipidemia as one of multiple risk factors (along with age, gender, smoking, hypertension, diabetes) to calculate overall cardiovascular disease risk. 3, 4
The American College of Cardiology/American Heart Association demonstrated that treating hyperlipidemia with atorvastatin in patients without previous myocardial infarction reduced coronary events by 36%, confirming its role as a preventive intervention for a risk factor rather than treatment of existing disease. 5