Hypercholesterolemia

Aka: Hypercholesterolemia, Hyperlipidemia, Familial Hypercholesterolemia, Familial Hyperlipidemia

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II. Causes: Familial Hypercholesterolemia

  1. General Findings
    1. LDL Cholesterol >190 mg/dl
    2. Premature, early onset coronary event (age <50 years)
      1. Coronary events may occur as early as age 17 years in males, and 25 years in females
  2. Homozygous Familial Hypercholesterolemia
    1. Corneal arcus senilis
    2. Xanthomas
  3. Heterozygous Familial Hypercholesterolemia
    1. Worldwide Prevalence: 1 in 250 to 350
    2. Silent severe Hyperlipidemia (LDL Cholesterol >190 mg/dl)
    3. No physical findings until premature cardiovascular events occur
  4. References
    1. Hu (2020) Circulation 141(22): 1742-59 [PubMed]

III. Causes: Other Secondary Causes of Hypercholesterolemia

  1. Genetic Cholesterol disorder findings
    1. See Familial Hypercholesterolemia as above
    2. LDL Cholesterol >190-200 mg/dl
    3. Serum Triglycerides > 1000 mg/dl
    4. HDL Cholesterol < 30 mg/dl
  2. Hypothyroidism
  3. Nephrotic Syndrome
  4. Chronic Liver Disease (Primary Biliary Cirrhosis)
  5. Dysglobulinemia
  6. Cushing's Syndrome
  7. Hyperparathyroidism
  8. Acute Intermittent Porphyria
  9. Medications
    1. Protease Inhibitors

IV. Screening: Guidelines

  1. General counseling for all patients
    1. Low Fat Diet
    2. Exercise Program
  2. Criteria for age to start screening
    1. NIH as of 2011 recommends screening all ages 9-11 and again at 17-21years
      1. Treat patients only with significant LDL increase (e.g. >190)
      2. Goal to identify Familial Hypercholesterolemia
    2. Age over 20 years (ATP III Guidelines)
      1. Screen at age 20 and then every 5 years
      2. Prior guidelines for age to start screening
        1. Age >34 years in men
        2. Age >44 years in women
    3. Ages 2 to 20 years
      1. Family History of Total Cholesterol >300 mg/dl
      2. Family History Premature Coronary Artery Disease
        1. Age under 56 years in men
        2. Age under 66 years in women
  3. Screening protocol (repeated every 5 years)
    1. Full Fasting lipid profile preferred (ATP III guide)
    2. Alternative protocol: Non-Fasting lipid screening
      1. NCEP reasoning for non-Fasting lipid screening
        1. Non-Fasting screening improves compliance
        2. Postprandial Triglyceride rise can be evaluated
          1. Related to atherosclerosis risk
      2. Protocol
        1. Obtain non-Fasting Total Cholesterol with HDL
      3. Criteria to perform Fasting full lipid panel
        1. No Cardiac Risk Factors: Cholesterol >240 mg/dl
        2. Cardiac Risk Factors: Cholesterol >200 mg/dl
        3. HDL Cholesterol <40 mg/dl
    3. Alternative protocol: Non-Fasting Non-HDL Cholesterol
      1. Non-HDL Cholesterol = VLDL + IDL + LDL
      2. Correlates very well with outcomes
      3. Convenient (Patient does not need to fast)
      4. Goal Non-HDL Cholesterol is 30 higher than LDL goal

V. Evaluation: Framingham Risk Score (FRS)

  1. http://www.nhlbi.nih.gov/about/framingham/riskabs.htm
  2. NCEP Framingham Online Calculator
    1. http://hin.nhlbi.nih.gov/atpiii/calculator.asp
  3. Results of lowering LDL Cholesterol
    1. Relative CAD risk reduced 1% per 1% LDL decrease

VI. Management: General

  1. See Hyperlipidemia Management
  2. Coronary Artery Disease Risk Factors
    1. Positive Risk Factors
      1. See Cardiac Risk Factors
    2. Negative Risk Factors (Protective)
      1. HDL Cholesterol over 60 mg/dl
  3. Available lipid lowering modalities
    1. Dietary changes
      1. Low Fat Diet
      2. Phytosterols (Plant Stanols) lower LDL Cholesterol
    2. Weight loss for Obesity
      1. Lowers LDL Cholesterol
      2. Improves Insulin sensitivity
    3. Aerobic Exercise
      1. Raises HDL Cholesterol
      2. Lowers Triglycerides
    4. Anti-hyperlipidemic Medications
    5. Tobacco Cessation (Increases HDL by 30%)

VII. Management: Less than two Cardiac Risk Factors

  1. Cholesterol Management
    1. Goal if LDL Cholesterol below 160 mg/dl (ideally <130)
    2. Low Fat Diet if LDL Cholesterol over 160 mg/dl
    3. Anti-hyperlipidemic if LDL Cholesterol over 190 mg/dl
  2. Monitoring
    1. Desirable lipids: Repeat Lipid panel in 5 years
    2. Borderline lipids: Repeat lipid panel in 1 year
    3. Elevated lipids: Repeat lipid panel in 3-6 months

VIII. Management: Two or more Cardiac Risk Factors

  1. Cholesterol Management
    1. Goal LDL Cholesterol below 130 mg/dl
    2. Low Fat Diet if LDL Cholesterol over 130 mg/dl
    3. Anti-hyperlipidemic indications
      1. LDL Cholesterol over 130 (FRS 10 year risk <20%)
      2. LDL Cholesterol over 160 (FRS 10 year risk <10%)
  2. Monitoring
    1. Desirable lipids: Repeat Lipid panel in 1-2 years
    2. Borderline lipids: Repeat lipid panel in 6 months
    3. Elevated lipids: Repeat lipid panel in 2-3 months

IX. Management: Coronary Artery Disease or equivalent

  1. Coronary Artery Disease equivalents
    1. Diabetes Mellitus
    2. Ten year Framingham Risk Score (FRS) 20% or higher
    3. Abdominal Aortic Aneurysm
    4. Peripheral Vascular Disease (e.g. Claudication)
    5. Symptomatic Carotid Artery disease
  2. Cholesterol Management
    1. Goal LDL Cholesterol below 100 (ideally <70 mg/dl)
    2. Low Fat Diet if LDL Cholesterol above 100 mg/dl
    3. Anti-hyperlipidemic if LDL Cholesterol over 130 mg/dl
  3. Monitoring
    1. Desirable lipids: Repeat Lipid panel in 6-12 months
    2. Borderline lipids: Repeat lipid panel in 2-3 months
    3. Elevated lipids: Repeat lipid panel in 6 weeks

X. Management: CAD with multiple uncontrolled risks

  1. Goal LDL Cholesterol below 70 mg/dl
  2. Low Fat Diet if LDL Cholesterol above 70 mg/dl
  3. Anti-hyperlipidemic if LDL Cholesterol over 100 mg/dl

XI. References

  1. (2001) JAMA 285:2486-97 [PubMed]
  2. Ahmed (1998) Am Fam Physician 57(9):2192-203 [PubMed]
  3. Grundy (1997) Circulation 95:2329-31 [PubMed]
  4. Grundy (1997) Am Fam Physician 55(6): 2250-8 [PubMed]
  5. Mosca (2002) Am Fam Physician 65(2):217-26 [PubMed]
  6. Safeer (2002) Am Fam Physician 65(5):871-80 [PubMed]
  7. Yeshuran (1995) South Med J 88:379-91 [PubMed]

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Related Studies

Ontology: Hypercholesterolemia (C0020443)

Definition (CSP) abnormally high levels of cholesterol in the blood.
Definition (MSH) A condition with abnormally high levels of CHOLESTEROL in the blood. It is defined as a cholesterol value exceeding the 95th percentile for the population.
Concepts Disease or Syndrome (T047)
MSH D006937
SnomedCT 267500001, 154740003, 13644009
LNC LA14292-9
English Hypercholesteremia, Hypercholesteremias, Hypercholesterolemias, HYPERCHOLESTEROLAEMIA, HYPERCHOLESTEROLEMIA, hypercholesteremia, hypercholesterolemia, hypercholesterolemia (diagnosis), Elevated cholesterol, Hypercholesterolemia [Disease/Finding], Hypercholesterolemia, elevated cholesterol, high blood cholesterol level, hypercholesteraemia, Elevated Cholesterol, Hypercholesteraemia, Hypercholesterolaemia, Hypercholesterolemia (disorder), Hypercholesterolemia, NOS, Hypercholesterolaemia, NOS, hypercholesterolaemia
French HYPERCHOLESTEROLEMIE, Hypercholestérémie, Hypercholestérolémies, Hypercholestérolémie
Portuguese HIPERCOLESTEROLEMIA, Colesterol elevado, Hipercolesterolemia, Hipercolesteremia
Spanish HIPERCOLESTEROLEMIA, hipercolesterolemia (trastorno), hipercolesterolemia, Elevación del colesterol, Hipercolesterolemia, Hipercolesteremia
German HYPERCHOLESTERINAEMIE, Hypercholesterolemie, Hypercholesteraemie, Hypercholesterinaemie, Erhoehtes Cholesterin, Hypercholesterinaemia, Hypercholesterinämie
Italian Colesterolo elevato, Ipercolesterolemia
Dutch hypercholesteremie, hypercholesterolemie, verhoogd cholesterol, Cholesterolemie, hyper-, Hypercholesterolemie
Japanese コレステロール上昇, ｺﾚｽﾃﾛｰﾙｼﾞｮｳｼｮｳ, ｺｳｺﾚｽﾃﾛｰﾙｹﾂｼｮｳ, ｺｳｺﾚｽﾃﾛｰﾙｹｯｼｮｳ, 高コレステリン血症, 高コレステロール血症, コレステリン血, コレステリン血症, コレステロール過剰血, コレステロール過剰血症, 高β-リポ蛋白血, 高β-リポ蛋白血症, 高コレステリン血, 高コレステロール血, 高βリポタンパク血症, 高βリポ蛋白血症, 高ベータリポタンパク血症, 高ベータリポ蛋白血症
Swedish Hyperkolesterolemi
Czech hypercholesterolémie, Zvýšený cholesterol, Hypercholesterolemie, vysoký cholesterol
Finnish Hyperkolesterolemia
Russian GIPERKHOLESTERINEMIIA, KHOLESTERINEMIIA, ГИПЕРХОЛЕСТЕРИНЕМИЯ, ХОЛЕСТЕРИНЕМИЯ
Croatian HIPERKOLESTEROLEMIJA
Polish Hipercholesterolemia, Hipercholesteremia
Hungarian Hypercholesteraemia, Hypercholesterinaemia, Megemelkedett koleszterin
Norwegian Hyperkolesterolemi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hypercholesterolemia, Familial (C0020445)

Definition (MSHCZE) Skupina familiárních onemocnění charakterizovaná zvýšenou cirkulací cholesterolu obsaženého buď v LIPOPTROTEINech LDL nebo v LIPOPTROTEINech VLDL (pre-beta lipoproteiny).
Definition (CSP) characterized by increased plasma concentration of cholesterol carried in low density lipoproteins (LDL) and by a deficiency in a cell surface receptor which regulates LDL degradation and cholesterol synthesis.
Definition (MSH) A group of familial disorders characterized by elevated circulating cholesterol contained in either LOW-DENSITY LIPOPROTEINS alone or also in VERY-LOW-DENSITY LIPOPROTEINS (pre-beta lipoproteins).
Concepts Disease or Syndrome (T047)
MSH D006938
ICD10 E78.0
SnomedCT 190775001, 389985001, 190772003, 31654005, 190776000, 190773008, 398036000
English Essential Hypercholesterolemia, Essential Hypercholesterolemias, Familial Hypercholesterolemias, Hyperbetalipoproteinemia, Hyperbetalipoproteinemias, Hypercholesterolemia, Essential, Hypercholesterolemia, Familial, Hypercholesterolemias, Essential, Hypercholesterolemias, Familial, familial hyperlipoproteinemia type II, Fam hyperbetalipoproteinaemia, Fam hyperbetalipoproteinemia, LDL-Low dens lipopro recep dis, Hyperlipoproteinemia Type II, Hyper Low Density Lipoproteinemia, Hyper-Low Density Lipoproteinemias, Hyper-Low Density Lipoproteinemia, Lipoproteinemia, Hyper-Low Density, Lipoproteinemias, Hyper-Low Density, HYPERLIPOPROTEINEMIA TYPE 02, familial hyperbetalipoproteinemia, familial hypercholesteremia, hyperbetalipoproteinemia (diagnosis), familial hypercholesterolemia, familial hypercholesterolemia (diagnosis), hyperbetalipoproteinemia, essential hypercholesterolemia (diagnosis), essential hypercholesterolemia, Fredrickson Type II hyperlipidemia, Fredrickson Type II lipidaemia, Fredrickson Type II lipidemia, Type II hyperlipidaemia, Type II hyperlipidemia, Type II lipidaemia, Type II lipidemia, Type 2, Hyperlipoproteinemia, Density Lipoproteinemias, Hyper-Low, Hyper-beta-Lipoproteinemia, Hyperlipoproteinemia Type 2, Density Lipoproteinemia, Hyper-Low, Hyper beta Lipoproteinemia, Hyper-beta-Lipoproteinemias, Hyperlipoproteinemia Type 2s, Hyperlipoproteinemia Type II [Disease/Finding], familial hypercholesterolaemia, hyperlipidemia type ii, type ii hyperlipoproteinemia, Hyperlipoproteinemia Type IIs, Hyper-Low-Density-Lipoproteinemia, Type II Hyperlipoproteinemias, Familial Hypercholesterolemic Xanthomatosis, Hypercholesterolemic Xanthomatosis, Familial, Hypercholesterolemic Xanthomatoses, Familial, Xanthomatoses, Familial Hypercholesterolemic, Hyper-Low-Density-Lipoproteinemias, Hyperlipoproteinemia, Type II, Familial Hypercholesterolemic Xanthomatoses, Xanthomatosis, Familial Hypercholesterolemic, Hyperlipoproteinemias, Type II, Type II Hyperlipoproteinemia, Familial Hypercholesterolemia, Familial hyperbetalipoproteinaemia (disorder), Fredrickson Type II hyperlipidaemia, Essential familial hypercholesterolemia, Familial hyperbetalipoproteinemia, Familial hypercholesterolemia, LDL receptor disorder, Low density lipoprotein catabolic defect, Familial hyperbetalipoproteinaemia, Familial hypercholesterolaemia, LDL - Low density lipoprotein receptor disorder, Essential familial hypercholesterolaemia, Hyperbetalipoproteinaemia, Familial hypercholesterolemia (disorder), Hyperbetalipoproteinemia (disorder), Type II Hyperlipidemia, Type II hyperlipoproteinaemia, Type II hyperlipoproteinemia
Italian Iperlipidemia di tipo II, Lipidemia di Fredrickson Tipo II, Iperlipoproteinemia tipo II, Iperlipemia di Fredrickson Tipo II, Ipercolesterolemia familiare, Iperlipoproteinemia di tipo II, Ipercolesterolemia essenziale
Dutch Fredrickson type II lipidemie, type II hyperlipoproteïnemie, type II lipidemie, familiale hypercholesterolemie, Fredrickson type II hyperlipidemie, type II hyperlipidemie
French Hyperlipidémie type II de Fredrickson, Hyperlipidémie de Fredrickson de type II, Hyperlipoprotéinémie type II, Lipidémie de type II, Lipidémie de Fredrickson type II, Lipidémie de Fredrickson de type II, Hyperlipoprotéinémie type 2, Hypercholestérolémie familiale, Hyperlipoprotéinémie de type II, Hyperlipoprotéinémie de type 2, Hyperlipidémie de type II, Hyperbêtalipoprotéinémie, Hypercholestérolémie essentielle
German familiaere Hypercholesterolemie, Familiaere Hypercholesterinaemie, Hyperlipoproteinaemie Typ II nach Frederickson, Typ II Hyperlipoproteinaemie, Typ II Lipidaemie, Fredrickson Typ II Lipidaemie, Fredrickson Typ II Hyperlipidaemie, Hyperlipoproteinaemie Typ II, HYPERLIPOPROTEINÄMIE TYP 02, Typ II Hyperlipidaemie, Hyperbetalipoproteinämie, Hypercholesterinämie, essentielle, Hypercholesterinämie, familiäre, Hyperlipoproteinämie Typ II
Portuguese Lipidemia tipo II, Hipercolesterolemia familiar, Hiperlipoproteinemia tipo II, Hiperlipidemia tipo II de Fredrickson, Lipidemia tipo II de Fredrickson, Hipercolesterolemia Familiar, Hiperlipoproteinemia Tipo II, Hiperlipidemia tipo II, Hiperbetalipoproteinemia, Hipercolesterolemia Essencial
Spanish Lipidemia de Fredrickson tipo II, Lipidemia de tipo II, Hipercolesterolemia familiar, Hiperllipidemia tipo II de Fredrickson, Hiperlipidemia de Fredrickson tipo II, Hiperlipoproteinemia de tipo II, Hiperlipoproteinemia tipo II, Hipercolesterolemia Familiar, Hiperlipoproteinemia Tipo II, trastorno del receptor LDL, hiperbetalipoproteinemia familiar, defecto catabólico de lipoproteína de baja densidad, hipercolesterolemia familiar esencial, hiperbetalipoproteinemia (trastorno), hiperbetalipoproteinemia, hipercolesterolemia familiar (trastorno), hipercolesterolemia familiar, Hiperlipidemia tipo II, Hiperbetalipoproteinemia, Hipercolesterolemia Esencial
Russian ГИПЕРЛИПОПРОТЕИНЕМИЯ II ТИПА, ГИПЕРХОЛЕСТЕРИНЕМИЯ СЕМЕЙНАЯ, GIPERKHOLESTERINEMIIA ESSENTSIAL'NAIA, GIPERKHOLESTERINEMIIA SEMEINAIA, GIPERLIPOPROTEINEMIIA TIPA II, GIPERBETALIPOPROTEINEMIIA, GIPERLIPOPROTEINEMIIA II TIPA, ГИПЕРБЕТАЛИПОПРОТЕИНЕМИЯ, ГИПЕРЛИПОПРОТЕИНЕМИЯ ТИПА II, ГИПЕРХОЛЕСТЕРИНЕМИЯ ЭССЕНЦИАЛЬНАЯ
Japanese ２型高脂血症, ２型高リポ蛋白血症, 2ｶﾞﾀｺｳﾘﾎﾟﾀﾝﾊﾟｸｹﾂｼｮｳ, 2ｶﾞﾀｺｳｼｹﾂｼｮｳ, ｶｿﾞｸｾｲｺｳｺﾚｽﾃﾛｰﾙｹｯｼｮｳ, 2ｶﾞﾀｺｳｼｹｯｼｮｳ, ｶｿﾞｸｾｲｺｳｺﾚｽﾃﾛｰﾙｹﾂｼｮｳ, 2ｶﾞﾀｺｳﾘﾎﾟﾀﾝﾊﾟｸｹｯｼｮｳ, 高リポ蛋白血症IIa型, 高リポ蛋白血症2型, 高リポ蛋白質血症IIa型, 家族性高リポタンパク血症IIa型, 高脂血症II型-家族性, 高リポ蛋白血症II型, 高リポタンパク血症2型, 高リポタンパク血症II型, 高リポたんぱく質血症II型, 家族性高脂血症II型, 高リポたんぱく質血症2型, 高コレステロール血症-家族性, 家族性IIa型高リポタンパク血症, 2型家族性高リポ蛋白血, 2型家族性高リポ蛋白血症, ベータリポタンパク過剰血症, 家族性コレステロール過剰血症, 家族性高コレステロール血, 家族性高コレステロール血症, 本態性コレステロール過剰血症, 高リポ蛋白質血症2型, コレステロール過剰血症-家族性, コレステロール過剰血症-本態性, ベータリポ蛋白過剰血症, 家族性IIa型高リポ蛋白血症, 本態性高コレステロール血症, 高コレステロール血症-本態性, 高リポ蛋白質血症II型
Swedish Hyperlipoproteinemi typ II
Czech hypercholesterolémie esenciální, hyperbetalipoproteinémie, hypercholesterolémie familiární, hyperlipoproteinémie typ II, Familiární hypercholesterolemie, Hyperlipoproteinemie typu II, Lipidemie typu II, Hyperlipidemie typu II, Lipidemie Fredricksonova typu II, Hyperlipidemie Fredricksonova typu II
Finnish Tyypin II hyperlipoproteinemia
Polish Hiperlipoproteinemia typ II, Hipercholesterolemia rodzinna
Hungarian Hyperlipidaemia II. típus, Hyperlipoproteinaemia II. típus, II. típusú hyperlipoproteinaemia, Lipidaemia II. típusú, Fredrickson hyperlipidaemia II. típus, II. típusú hyperlipidaemia, II. típusú lipidaemia, Öröklött hypercholesterinaemia, Fredrickson-II típus lipidemia, Fredrickson II. típusú hyperlipidaemia, Lipidaemia Fredrickson II. típus, Familiaris hypercholesterinaemia
Norwegian Hyperlipoproteinemi type 2, Homozygot familiær hyperkolesterolemi, Hyperlipoproteinemi type II, Müller-Harbitz’ sykdom
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hyperlipidemia (C0020473)

Definition (NCI) Elevated levels of lipids in the blood.
Definition (CSP) excess of lipids in the blood.
Definition (MSH) Conditions with excess LIPIDS in the blood.
Concepts Disease or Syndrome (T047)
MSH D006949
ICD10 E78.5
SnomedCT 154743001, 190782002, 154739000, 267499005, 55822004
English Hyperlipemia, Hyperlipemias, HYPERLIPAEMIA, Hyperlipidaemia NOS, Hyperlipidaemia, unspecified, Hyperlipidemia, unspecified, Hyperlipidemias, Hyperlipidemia NOS, hyperlipemia, hyperlipidemia (diagnosis), hyperlipidemia, Hyperlipaemia, Hyperlipidemias [Disease/Finding], lipidaemia, excessive fat in the blood, hyperlipidaemias, hyperlipidemias, lipidemia, Hyperlipidaemia NOS (disorder), Hyperlipidemia NOS (disorder), Disorder characterized by hyperlipidemia, Hyperlipidaemia, Lipidemia, HLD - Hyperlipidaemia, HLD - Hyperlipidemia, Hyperlipidemia (disorder), Lipidaemia, lipemia, lipoidemia, Hyperlipidemia, NOS, Hyperlipidaemia, NOS, Hyperlipidemia, hyperlipidaemia
Portuguese HIPERLIPEMIA, Hiperlipidemia NE, Hiperlipidemias, Hiperlipidemia, Hiperlipemia
Spanish HIPERLIPEMIA, Hiperlipidemia NEOM, Hiperlipidemias, hiperlipidemia, SAI (trastorno), hiperlipidemia, SAI, Hyperlipidaemia NOS, Hyperlipidemia NOS, hiperlipemia, hiperlipidemia (trastorno), hiperlipidemia, Hiperlipidemia, Hiperlipemia
Dutch hyperlipemie, hyperlipidemie NAO, Hyperlipidemie, niet gespecificeerd, hyperlipidemie
French Hyperlipidémie SAI, Hyperlipidémie, HYPERLIPEMIE, Hyperlipémies, Hyperlipidémies, Hyperlipémie
German Hyperlipaemie, Hyperlipidaemie NNB, HYPERLIPAEMIE, Hyperlipidaemie, nicht naeher bezeichnet, Hyperlipidaemie, Hyperlipämie, Hyperlipidämie
Italian Iperlipidemia NAS, Condizione iperlipidemica, Lipidi elevati, Valori lipidici elevati, Iperlipidemia, Iperlipemia
Russian ГИПЕРЛИПИДЕМИИ, GIPERLIPEMIIA, GIPERLIPIDEMII, LIPEMIIA, ГИПЕРЛИПЕМИЯ, ЛИПЕМИЯ
Japanese 高脂血症ＮＯＳ, ｺｳｼｹｯｼｮｳNOS, ｺｳｼｹｯｼｮｳ, ｺｳｼｹﾂｼｮｳNOS, ｺｳｼｹﾂｼｮｳ, 高脂質血, 高脂血症, 脂血症, 脂肪過剰血, 脂質過剰血症, 脂肪血症, 高脂肪血症, リポイド過多血症, 高脂血症(コウシケツショウ), 脂質異常症, 高脂質血症
Swedish Hyperlipemier
Czech hyperlipémie, hyperlipidémie, Hyperlipidemie NOS, Hyperlipemie, Hyperlipidemie
Finnish Hyperlipidemiat
Korean 상세불명의 고지혈증
Croatian HIPERLIPIDEMIJA
Polish Hiperlipidemia samoistna rodzinna, Hiperlipidemie
Hungarian Hyperlipidaemia, Hyperlipaemia, Hyperlipidaemia k.m.n.
Norwegian Høyt blodfett, Hyperlipidemier, Hyperlipemi, Hyperlipidemi
Derived from the NIH UMLS (Unified Medical Language System)

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