Hyperlipidemia refers to increased levels of circulating triglycerides in the blood. This differs from hyperlipemia which is a specific disease state related to hyperlipidemia. [1]

Hyperlipidemia occurs in any animal that is in a negative energy balance because of decreased feed intake or increased caloric need. This calorie deficit activates a normal physiological process whereby stored fat (lipids) are released into the blood to be used for energy.

The life-threatening condition of hyperlipemia is limited to ponies, miniature horses, and donkeys with insulin resistance. In these animals, blood levels of lipids become high enough to result in liver and renal failure due to excessive accumulation of lipids in these tissues. In severe cases, hyperlipemia can be fatal.

The main sign of hyperlipemia is inappetence, where the animal remains disinterested in food, even after feeds have been reintroduced or any underlying illness is addressed.

If you’re concerned your mini, donkey or pony may be showing signs of hyperlipemia after a period of decreased feed intake, consult with your veterinarian immediately to support their recovery.

Our nutritionists can help you formulate a diet to support your horse’s metabolic health and reduce the risk of this condition.

Hyperlipidemia vs Hyperlipemia

Both these conditions involve elevated levels of circulating fats (lipids) in blood. Hyperlipidemia refers to a natural state whereas hyperlipemia is a specific disease that can be fatal.


Hyperlipidemia refers to elevated blood lipids that occur during periods of negative energy balance, including:

  • Prolonged intervals between meals
  • Restricted feeding
  • Illness that causes loss of appetite
  • Increased energy demand including pregnancy and lactation

In a study of overweight Caspian miniature horses, hyperlipidemia occurred within 48 hours of feed deprivation. [2]

Hyperlipidemia can also occur in horses that are overweight/obese with metabolic disease without a decrease in feed intake. These hyperlipidemic changes are usually mild but can be quite severe on occasion. [11]


As with hyperlipidemia, hyperlipemia develops after fasting, severe illness that suppresses appetite and during an energy crisis associated with pregnancy or lactation.

However, unlike hyperlipidemia, the disease state of lipemia involves accumulation of fat in organs such as the liver and kidney. This can be impair their function and is fatal in severe cases.

Mad About Horses
Join Dr. Chris Mortensen, PhD on an exciting adventure into the story of the horse and learn how we can make the world a better place for all equines.
Apple Podcasts Spotify Youtube
Mad Barn Equine Nutrition Consultants

Causes of Hyperlipidemia and Hyperlipemia in Horses

Energy deficit

When animals are in negative energy balance they draw on their fat reserves to provide energy to the rest of the body. Fat that is stored in adipose tissue is mobilized and released into the blood as free fatty acids to be delivered to tissues that need cellular energy.

When the mobilization exceeds what the tissues need, the excess free fatty acids are removed by the liver and converted into triglycerides. The triglycerides are released back into blood packaged into large particles called very low density lipoproteins (VLDL). As LDL increases, it can affect metabolic pathways and reduce insulin sensitivity, perpetuating a vicious cycle of fat mobilization and hypertriglyceridemia.

Therefore, hyperlipidemia involves elevated levels of lipids in the form of free fatty acids (released from adipose tissue) and elevated levels of triglycerides (released by the liver in VLDL particles).

This is a normal physiological response that continues until the horse finds food and returns to a positive energy balance.

However, this response can become exaggerated and inappropriate in minis, donkeys and ponies with metabolic syndrome on a severely restricted weight loss diet or that abruptly go off their feed. This is a disease called hyperlipemia. [1]

Metabolic syndrome

In metabolic syndrome, insulin resistance means that the normal suppression of fat breakdown in adipose tissue by insulin is impaired. Therefore, overweight horses with insulin resistance have more abundant fat stores that are more likely to release excess free fatty acids into blood.

Certain drugs tested in horses with metabolic syndrome can also cause hyperlipidemia. For example, SGLT2 inhibitors which cause loss of glucose in the urine create an energy deficit leading to hyperlipidemia and an increase in