Familial combined hyperlipidemia

• Alternative Names

  Multiple lipoprotein-type hyperlipidemia

• Causes, incidence, and risk factors

  Familial combined hyperlipidemia is the most common disorder of increased blood fats that causes early heart attacks. It is genetic, which means it is caused by a problem with your genes. However, researchers have not yet identified the specific genes responsible.

  Diabetes, alcoholism, and hypothyroidism make the condition worse. Risk factors include a family history of high cholesterol and early coronary artery disease.

• Symptoms

  People with this condition develop high cholesterol or triglyceride levels during the teenage years. The levels remain high throughout life. They have an increased risk of early coronary artery disease and, therefore, heart attacks. People with familial combined hyperlipidemia have a higher rate of obesity and glucose intolerance.

  Chest pain (angina) may occur. However, there may not be any physical symptoms.

• Signs and tests

  Blood tests will be done to check your levels of cholesterol and triglycerides. Specific tests include:

  • Serum LDL
  • Serum HDL cholesterol
  • Triglycerides
  • Apolipoprotein B100 test

  Genetic testing is available for one type of familial combined hyperlipidemia.

• Treatment

  The goal of treatment is to reduce the risk of atherosclerotic heart disease.

  The first step is to change what you eat. This is tried for several months before drug therapy is added. Diet changes include reducing total fat intake to less than 30% of the total calories consumed. Saturated fat intake is reduced by decreasing the amounts of beef, chicken, pork, and lamb; by substituting low-fat dairy products for full-fat ones; and by eliminating coconut and palm oils. Cholesterol intake is reduced by eliminating egg yolks and organ meats.

  Further reductions in dietary fat may be recommended after the initial trial period. Dietary counseling is often recommended to help people make these adjustments to their eating habits. Weight loss and regular exercise may also aid in lowering cholesterol levels.

  Your doctor may recommend medicine if diet, exercise, and weight loss efforts have not lowered your cholesterol levels. Cholesterol-lowering medicines include:

  • Bile acid-sequestering resins
  • Fibrates (such as gemfibrozil)
  • Nicotinic acid
  • Statins
• Expectations (prognosis)

  How well a person does depends on how early the condition is diagnosed, when treatment is received, and whether treatment is followed. Without treatment, heart attack or stroke may cause early death.

  Some people may have such high lipid levels that an increased risk of heart attack remains despite medical therapy.

• Complications
  • Early atherosclerotic heart disease
  • Heart attack
  • Stroke
• Calling your health care provider

  Call your health care provider if you have warning symptoms of heart attack or your screening total cholesterol or triglycerides are high.

• Prevention

  A low-cholesterol, low-saturated fat diet in high-risk individuals may help to control LDL levels.

  If someone in your family has this condition, you may want to consider genetic screening for yourself or your children. Sometimes younger children may have mild hyperlipidemia.

  It is important to control other risk factors for early heart attacks, such as smoking, if you have this disease.

Review Date: 1/23/2008

Reviewed By: Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.