Lipids are fats and fat-like substances in the blood. Cholesterol and triglycerides are lipids. Your body uses cholesterol to build and maintain cells and to make some hormones. After eating, energy that is not needed right away is converted into triglycerides, which is stored in fat cells.

While having some cholesterol and triglycerides in the blood is important for the body to function properly, having too much is unhealthy. Having high levels of lipids is called hyperlipidemia.

There are many possible causes for high lipid levels, including HIV and some of the HIV drugs. This puts HIV+ people at particular risk for developing hyperlipidemia. Although you cannot tell if you have this condition without lab tests, it can cause serious long-term health problems.

The main danger of hyperlipidemia is heart disease. If you have too much cholesterol in your blood it can build up in your arteries (blood vessels), forming plaque. This buildup of plaque can lead to a heart attack or a stroke. High triglycerides can also increase your risk of getting pancreatitis (a painful inflammation of the pancreas).

Some HIV+ people experience lipodystrophy. Lipodystrophy includes hyperlipidemia, as well as other unwanted changes in body fat and blood sugar levels. These changes have been linked with diabetes, heart disease, and strokes. (For more info, see TWP sheets on lipodystrophy).

There are two main kinds of cholesterol. One is low-density lipoproteins (LDL) or “bad” cholesterol, which can clog the arteries. The higher your LDL, the higher your risk of heart disease. The other is high-density lipoproteins (HDL) or “good” cholesterol, which can help reduce the risk of heart disease.

Your health care provider can tell you if you have high cholesterol or triglycerides by doing a simple blood test called a fasting lipid profile. This will measure total cholesterol, HDL, LDL, and triglycerides. (You should have nothing to eat or drink for 8-12 hours before the test is done.) The following levels are ideal:

• Total cholesterol – less than 200
• Low-density lipoproteins (LDL) – less than 100
• High-density lipoproteins (HDL) – 60 or higher
• Triglycerides – less than 150

There are several types of fat found in the foods we eat including saturated, polyunsaturated, and monounsaturated. Saturated fat raises cholesterol the most. It is considered “bad” fat. Polyunsaturated and monounsaturated fats tend to keep cholesterol low and are considered to be “good” fats.

Saturated fat is usually solid at room temperature. It is found in the fat of animal products like meats and dairy. It is also found in a few vegetable products like coconut, palm, and palm kernel oil. To keep saturated fat low, check the label and choose dairy products with low saturated fat like skim or 1 percent milk, tub spreads, and low fat cheese and ice cream. When you are buying meats, choose cuts called “loin” or “round” – these are the leanest.

Polyunsaturated and monounsaturated fats (“good” fats) include oils, mayonnaise, nuts and avocados. If you use oil in cooking, the two best choices are canola and olive oil.

Eating a lot of “refined” carbohydrates – sugary foods, soda, and white bread can raise triglycerides. If you need to reduce total cholesterol, LDL, and triglyceride levels it is important to limit the amount of bad fats and excess sugar in your diet. See a registered dietitian to help you make good choices and plan your meals. Many AIDS service organizations have registered dietitians on staff who will see you free of charge. (For more info, see TWP sheet on nutrition).

Aerobic, or cardiovascular exercise, is the kind of exercise that will help lower your lipid levels. It has been found to lower total cholesterol, triglycerides, and LDL and can raise HDL!

Aerobic exercises include fast walking, jogging, swimming, bicycling, and stair climbing. Try to work out at least three times a week for 20-30 minutes.

Sometimes, despite diet and exercise, lipids can’t be controlled well enough without the help of drugs. There are a variety of drugs available to help lower cholesterol and triglycerides. Some of these may interact with HIV drugs. To reduce the chance of drug interactions, make sure your health care provider is aware of all the medications you take.

If you take a lipid-lowering drug, it is still important to include a good diet and exercise in your lifestyle to help the drug work its best. Also remember to take the drug consistently.

Some HIV drugs have been:

• Found to cause changes in lipid levels
• Tied to diabetes—another risk factor for heart disease
• Linked to an increased risk of heart attacks, for reasons that are not clearly understood

While experts agree that heart disease risks are associated with some HIV medications, there are also important benefits to the heart and immune system from HIV treatment. It is important to work with your health care provider to weigh the risks and benefits of the HIV medications you choose.

There are some HIV drugs that have less of an impact on cholesterol and triglycerides. These include Viramune (nevirapine), Intelence (etravirine), Isentress (raltegravir), and Selzentry (maraviroc). Reyataz (atazanavir) and Prezista (darunavir) are also less likely to increase lipids, but both require use with Norvir (ritonavir), and Norvir does increase lipids.

If you take HIV drugs, be aware of the possible side effects. Get monitored at regular medical check ups for high lipid levels. Do not stop or make changes to your HIV drug regimen without speaking to your health care provider.

Other risk factors for heart diseases include:

• Family history of heart disease
• Little or no exercise
• High fat, high sugar diet
• High blood pressure
• Age (women over 55, men over 45)
• Obesity
• Diabetes
• Smoking
  

Try these tips for lowering cholesterol and triglycerides and decreasing other risk factors:

• Avoid fried foods
• Avoid adding extra fats like butter, sour cream, dressings, and gravies to foods
• Limit sweets and snack foods
• Cut excess fat and skin off of meats
• Choose skim or 1 percent milk instead of whole or 2 percent milk
• Limit cheese or try low fat cheeses
• Choose whole grain breads instead of white breads
• Increase fiber with whole grains, fruits and vegetables, and cooked beans
• Eat fish three times a week
• Increase aerobic exercise to three or four times a week for 30 minutes or more
• If your health care provider has prescribed lipid-lowering drugs, make sure to take them consistently
• Try to lose weight if you are overweight
• If you smoke, try to quit or at least cut down

If you have hyperlipidemia, it is especially important to take care of your body. Keep all of your medical appointments, get regular lab tests, and tell your health care provider about any changes in the way you feel or in your body shape.

Hyperlipidemia and other conditions associated with lipodystrophy have been linked with heart disease and strokes in HIV+ people, so make sure you are monitored closely. Other factors also contribute to the risk of heart attacks and strokes, including high blood pressure. If you have high blood pressure, make sure it is treated. You can also support your body, and especially your heart, with a healthy diet, regular exercise, and giving up smoking.