The present study focuses on the non-nutritional causes of dyslipidemia, including an increase in both atherogenic (LDL) and antiatherogenic (HDL) lipid fractions. The prospective study included 180 patients aged 30-65 years with a normal BMI, but persistent changes in the lipid profile that persisted despite dieting. A comprehensive analysis of endocrine, genetic, microbiomic, and environmental factors, as well as their relationship to clinical manifestations, has been performed. The results revealed a high prevalence of non-nutritional causes of dyslipidemia: 18% of patients had subclinical hypothyroidism, 15% had genetic variants in the LDLR, PCSK9, and APOE genes, and 22% had elevated levels of heavy metals (cadmium, lead). The characteristic external signs were local lipid deposits (xanthelasms, tendon xanthomas) and specific skin changes ("greasy" shine, hyperemia), independent of BMI. Patients with elevated HDL exhibit a paradoxical phenotype, characterized by a combination of high HDL levels with signs of early aging and vascular changes. The study confirmed the importance of chronic stress, sleep disorders, and occupational hazards in the development of dyslipidemia. The findings underscore the importance of advanced diagnosis in patients with dyslipidemia of unknown origin, including assessments of hormonal status, microbiome, and toxicological screening. The results open up new possibilities for personalized
