Dyslipidaemia: what it is, the different types and how it is treated under the European guideline

Dyslipidaemia is an abnormality of the lipids (fats) in the blood: LDL cholesterol or triglycerides are high, or HDL cholesterol is low. It is very common. In Spain, the ENRICA study found high cholesterol in half of all adults. To treat it, your doctor works out your overall cardiovascular risk and uses that to decide whether lifestyle changes are enough or whether you need medication. When medication is needed, the first step is a statin.

What dyslipidaemia is and the different types

Dyslipidaemia is the clinical term for any abnormality of the lipids circulating in the blood. That makes it an umbrella term. A blood test can be abnormal in several different ways, and it helps to know which one applies to you, because they are not all managed in the same way.

• High LDL cholesterol (hypercholesterolaemia): this is the type of cholesterol most studied as a treatment target, and the European guideline bases its targets on it.
• High triglycerides (hypertriglyceridaemia): these usually go hand in hand with excess weight and blood sugar problems. We cover this in detail in our guide on why triglycerides go up and how to bring them down.
• Low HDL cholesterol: this is the so-called 'good' cholesterol, and it is often low alongside high triglycerides.
• Mixed dyslipidaemia: when the same person has more than one of these abnormalities.

Dyslipidaemia does not usually cause symptoms. It is normally picked up on a routine blood test, which is why it can go unnoticed for years.

How many people in Spain have dyslipidaemia

The ENRICA study, published in Revista Española de Cardiología in 2012, looked at 11,554 adults representative of the Spanish population between 2008 and 2010. Of these, 50.5% had hypercholesterolaemia (total cholesterol of 200 mg/dl or above, or taking medication for it) and 44.9% had high LDL (130 mg/dl or above, or taking medication for it). There were no major differences between men and women.

There are two caveats. First, these figures are more than fifteen years old, and we have not found a more recent national figure that is as robust. Second, these thresholds are used to group people in a study. They do not decide who is safe. A total cholesterol below 200 mg/dl does not mean you have no risk. The right level for each person depends on their overall cardiovascular risk.

Why lowering LDL matters

The reason for treating LDL is that lowering it reduces heart attacks and strokes, and this has been measured. The Cholesterol Treatment Trialists (CTT) meta-analysis, published in The Lancet in 2010 and covering 26 trials, calculated that every 1 mmol/l (about 39 mg/dl) reduction in LDL cuts major vascular events by 22% in relative terms. This is a relative reduction. How much each person benefits in absolute terms depends on their starting risk, which is why guidelines put so much weight on calculating that risk accurately.

How dyslipidaemia is treated: what the 2025 ESC/EAS guideline says

The main reference in Europe is the dyslipidaemia guideline from the European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS). Its 2025 update contains a change that is sometimes reported the wrong way round: the LDL targets are the same as in 2019. What changes is how to reach them.

• Stepping up treatment intensity sooner, rather than waiting a long time at each step.
• Making more use of drug combinations when one drug alone is not enough.
• Calculating risk more accurately with the SCORE2 and SCORE2-OP scores (the latter is designed for older people).
• Giving bempedoic acid a class I recommendation, the strongest level in the guideline.

When medication is needed, the guideline sets out an order: a statin first and then, if the target is not reached, other drugs with proven cardiovascular benefit, such as ezetimibe, PCSK9 inhibitors and bempedoic acid. Which step applies, with what target and in what combination is an individual decision. It depends on your calculated risk, any other conditions you have and how well you tolerate the medicines.

In Spain, the Spanish Agency of Medicines and Medical Devices (AEMPS) published its Therapeutic Positioning Report (IPT 38/2022) on bempedoic acid (Nilemdo) and its combination with ezetimibe (Nustendi) in 2022. Spain's Interministerial Committee on Medicinal Product Pricing proposed public funding for both on 24 July 2023. The current funding and prior-authorisation (visado) conditions can be checked in the Spanish Ministry of Health's Nomenclátor.

Dyslipidaemia and excess weight: what weight loss does

When dyslipidaemia and excess weight occur together, losing weight mainly improves triglycerides and HDL. A classic meta-analysis by Dattilo and Kris-Etherton (American Journal of Clinical Nutrition, 1992) calculated that, once weight has stabilised, every kilo lost lowers triglycerides by 1.33 mg/dl and raises HDL by 0.35 mg/dl.

For LDL, there is no equivalent figure we can give you with confidence. And losing weight does not guarantee that your cholesterol will return to normal: some people lose weight and still need medication to reach their LDL target. The two do not compete. That is why doctors often treat weight and LDL at the same time rather than one after the other, especially when risk is high.

This combination of high triglycerides, low HDL and excess abdominal fat is often part of a wider picture, metabolic syndrome, and it frequently goes hand in hand with insulin resistance. Looking at the whole picture helps explain why your doctor assesses your overall risk rather than a single number on a blood test.

Omega-3: a supplement is not the same as a prescription medicine

There is a lot of confusion here. A 2018 Cochrane review of 79 trials and 112,059 people concluded that long-chain omega-3 supplements (EPA and DHA) do not reduce cardiovascular disease, stroke or mortality.

The REDUCE-IT trial (NEJM, 2019) produced a different result, but with a different product and different patients. It studied icosapent ethyl, a purified EPA that is a prescription medicine, in 8,179 people with triglycerides between 135 and 499 mg/dl who were already taking a statin and had cardiovascular disease or diabetes plus other risk factors. In these patients it reduced cardiovascular events (the primary endpoint) by 25%, cardiovascular death by 20%, heart attacks by 31% and strokes by 28%. That result cannot be applied to omega-3 capsules bought from a pharmacy or health food shop.

Key points and where to start

Dyslipidaemia is very common, causes no symptoms and is treated according to overall cardiovascular risk. Lowering LDL reduces events by a measurable amount, losing weight improves triglycerides and HDL, and one does not replace the other. If you have excess weight as well as abnormal blood test results, medical weight-loss treatment is available in Spain today, with an assessment beforehand, a prescription from a doctor registered with the Spanish medical council where appropriate, and ongoing follow-up. That is what AiON offers. If you would like to know whether it is right for you, you can:

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