CoChat
Sign Up
Cited by 199Lipid metabolism and disordersLipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and Lipoproteins

Secondary causes of hyperlipidemia.

Stone, Neil J.·1994·Medical Clinics of North America
DOI 10.1016/s0025-7125(16)30179-1
Open this paper in CoChat — free account

Abstract

Secondary causes of hyperlipidemia are important to recognize. In fact, hyperlipidemia may be a clue to the presence of an underlying systemic disorder. It may greatly heighten the risk of atherosclerosis with a raised LDL-c, triglyceride-rich lipoprotein excess, and increased lipoprotein(a) as well as lowered HDL-c. The search for secondary causes may provide a clue as to why patients with primary lipid disorders suddenly develop worsening lipid profiles. The point is a crucial one because some acquired causes of hyperlipidemia, such as alcohol, estrogens, steroids, or pregnancy, when superimposed on a primary familial form of hypertriglyceridemia can result in a saturated removal system and a buildup of chylomicrons, which can lead to life-threatening pancreatitis. A convenient way to remember secondary causes is to think of the four D's of diet, drugs, disorders of metabolism, and diseases. Although diets rich in saturated fats and cholesterol are a common cause of the mild hypercholesterolemia seen in our society, alcohol excess and weight gain can explain much of the tendency toward hypertriglyceridemia. Interestingly anorexia nervosa has long been associated with severe but reversible hypercholesterolemia. Several classes of drugs need to be considered as common causes of altered lipid profiles. Glucocorticoids and estrogens elevate triglycerides and raise levels of HDL-c. Anabolic steroids taken orally markedly reduce levels of HDL-c in contrast to injectable testosterone, which does not adversely affect the LDL-to-HDL ratio. Oral contraceptives affect atherosclerotic risk depending on the kind and doses of progestin/estrogen. In those with an underlying primary hypertriglyceridemia and associated obesity, estrogenic medications can depress triglyceride removal mechanisms, leading to the chylomicronemia syndrome and pancreatitis. Antihypertensives have variable effects on lipids and lipoproteins. Although short-term thiazide usage raises cholesterol, triglycerides, and LDL-c, long-term usage is not necessarily associated with significant alterations in lipid levels. Alpha blockers may cause an increase in HDL-c, whereas beta blockers raise triglycerides and lower HDL-c. Sympatholytics, angiotensin converting enzyme inhibitors, and calcium channel blockers are essentially lipid neutral. Retinoids can be associated with increased LDL-to-HDL ratios and occasionally striking elevations in triglycerides. Cyclosporine raises LDL-c and lipoprotein(a). Classes of drugs that may raise HDL-c include cimetidine, antiepileptic drugs, and tamoxifen, but the effect may be seen primarily in women. Hypothyroidism is the most common secondary cause of hyperlipidemia after dietary causes are considered. A thyroxine and TSH level should be obtained on all new cases of clinically important hyperlipidemia.(ABSTRACT TRUNCATED AT 400 WORDS)

Integrity signals

Registry

Crossref · 10.1016/s0025-7125(16)30179-1

Cites

149 of 149 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Glucocorticoids have several effects on lipoprotein metabolism including increased cholesterol production, increased fatty acid synthesis, and decreased clearance of triglyceride-rich lipoproteins.

    “Glucocorticoids have several effects on lipoprotein metabolism including increased cholesterol production from induction of hydroxymethylglutaryl coenzyme A reductase, increased fatty acid synthesis due to increased expression of fatty acid synthase, and decreased clearance of triglyceride-rich lipoproteins (94).”

    From Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline (2012) · cites this paper as [94]

  • The hypertriglyceridemic effect of beta-adrenergic blocking agents is greater for atenolol, metoprolol, and propranolol than for carvedilol.

    “The hypertriglyceridemic effect of ␤-adrenergic blocking agents is greater for atenolol, metoprolol, and propranolol than for carvedilol.”

    From Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline (2012) · cites this paper as [94]

  • The triglyceride-raising effects of antihypertensive drugs are most relevant in patients with underlying genetic hypertriglyceridemia.

    “These effects are most relevant in patients with underlying genetic hypertriglyceridemia (94).”

    From Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline (2012) · cites this paper as [94]

  • Antihypertensive drugs with a potential to increase triglyceride levels are thiazide (and furosemide) diuretics and beta-adrenergic blocking agents.

    “Antihypertensive drugs with a potential to increase triglyceride levels are thiazide (and furosemide) diuretics and ␤-adrenergic blocking agents.”

    From Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline (2012) · cites this paper as [94]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Stone, N. J.
Affiliations
Northwestern University (US)
Corresponding author
Stone, Neil J.
ORCID
Stone, Neil J.
Venue
Medical Clinics of North America
Publisher
Elsevier BV
Published
1994-01
Volume
78
Issue
1
Pages
117-141
ISSN
0025-7125 (ISSN-L)
DOI
10.1016/s0025-7125(16)30179-1
OpenAlex
W170653800
Cited by
199
References
149
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 9 · 2022: 5 · 2021: 6 · 2020: 10 · 2019: 6 · 2018: 11 · 2017: 5 · 2016: 5 · 2015: 12 · 2014: 4 · 2013: 9 · 2012: 8
FWCI
4.43
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Medical Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
secondary hyperlipidemia, familial hypertriglyceridemia, chylomicronemia syndrome, pancreatitis, glucocorticoids, anabolic steroids, oral contraceptives, thiazide diuretics, beta-blockers, alpha-blockers, retinoids, cyclosporine, anorexia nervosa, diet, atherosclerosis
MeSH terms
Humans, Hyperlipidemias

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review