High cholesterol, clinically referred to as hyperlipidemia or dyslipidemia, is a metabolic disorder characterized by elevated levels of circulating lipids—primarily low-density lipoprotein cholesterol (LDL-C), triglycerides, or reduced high-density lipoprotein cholesterol (HDL-C). Among these, elevated LDL cholesterol is the principal contributor to atherosclerotic cardiovascular disease (ASCVD).

Pathophysiologically, excess LDL cholesterol penetrates the arterial intima, where it undergoes oxidation and triggers an inflammatory cascade. This leads to the formation of atherosclerotic plaques composed of lipid cores, inflammatory cells, and fibrous tissue. Progressive plaque growth results in arterial narrowing, endothelial dysfunction, and plaque instability, significantly increasing the risk of coronary artery disease, myocardial infarction, ischemic stroke, and peripheral artery disease.

Hyperlipidemia is often asymptomatic and remains undetected until advanced cardiovascular disease manifests. Risk factors include unhealthy dietary patterns (high saturated and trans fats), obesity, insulin resistance, diabetes mellitus, physical inactivity, smoking, chronic stress, and genetic predisposition. In the UAE, the high prevalence of metabolic syndrome and diabetes significantly amplifies cardiovascular risk related to dyslipidemia.

Diagnosis is established through fasting or non-fasting lipid profiling, including total cholesterol, LDL-C, HDL-C, triglycerides, and increasingly non-HDL cholesterol and apolipoprotein B in high-risk patients. Cardiovascular risk stratification is essential to guide treatment intensity.

Management is risk-based and includes aggressive lifestyle modification alongside pharmacotherapy. Statins remain first-line agents due to their proven efficacy in reducing LDL cholesterol and cardiovascular events. In patients with inadequate response or statin intolerance, ezetimibe, PCSK9 inhibitors, or newer lipid-lowering agents may be indicated. Long-term adherence and monitoring are critical, as cholesterol management is preventive rather than curative.