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Familial combined hyperlipidemia

Multiple lipoprotein-type hyperlipidemia

Familial combined hyperlipidemia is a disorder that is passed down through families. It causes high cholesterol and high blood triglycerides.

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Coronary artery blockage
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Causes

Familial combined hyperlipidemia is the most common genetic disorder that increases blood fats. It can cause early heart attacks.

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

Symptoms

In the early years, there may be no symptoms.

When symptoms appear, they may include:

People with this condition may develop high cholesterol or high triglyceride levels as teenagers. The condition may also be diagnosed when people are in their 20s and 30s. The levels remain high all during life. Those with familial combined hyperlipidemia have an increased risk of early coronary artery disease and heart attacks. They also have higher rates of obesity and are more likely to have glucose intolerance.

Exams and Tests

Blood tests will be done to check your levels of cholesterol and triglycerides. Tests will show:

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.

LIFESTYLE CHANGES

The first step is to change what you eat. Most of the time, you will try diet changes for several months before your doctor recommends medicines. Diet changes include lowering the amount of saturated fat and refined sugar.

Here are some changes you can make:

Counseling is often recommended to help people make changes to their eating habits. Weight loss and regular exercise may also help lower your cholesterol levels.

MEDICINES

If lifestyle changes do not change your cholesterol levels enough, or you are at very high risk for atherosclerotic heart disease, your health care provider may recommend that you take medicines. There are several types of drugs to help lower blood cholesterol levels.

The drugs work in different ways to help you achieve healthy lipid levels. Some are better at lowering LDL cholesterol, some are good at lowering triglycerides, while others help raise HDL cholesterol.

The most commonly used, and most effective drugs for treating high LDL cholesterol are called statins. They include lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), rosuvastatin (Crestor), and pitivastatin (Livalo).

Other cholesterol-lowering medicines include:

Outlook (Prognosis)

How well you do depends on:

Without treatment, heart attack or stroke may cause early death.

Even with medicine, some people may continue to have high lipid levels that increase their risk for heart attack.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Seek medical care right away if you have chest pain or other warning signs of a heart attack.

Call your provider if you have a personal or family history of high cholesterol levels.

Prevention

A diet that is low in cholesterol and saturated fat may help to control LDL levels in people at high risk.

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.

Related Information

High blood cholesterol levels
Cardiovascular
Stable angina
Diabetes
Hypothyroidism

References

Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 48.

Robinson JG. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 195.

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Review Date: 6/25/2020  

Reviewed By: Micaela Iantorno, MD, MSc, FAHA, RPVI, Interventional Cardiologist at Mary Washington Hospital Center, Fredericksburg, VA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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