Alternate Names: Multiple lipoprotein-type hyperlipidemia

Causes and Risks: The cause of this disease is a defective gene. Elevations in the cholesterol and/or triglyceride levels appear during the teenage years and continue throughout life. Types of elevated lipoproteins may vary between affected family members. Cholesterol deposits in the skin, called xanthomas, that are seen in other disorders of elevated lipoproteins are not seen in this disorder. This disorder predisposes the person to increased risk of early coronary artery disease. The incidence of obesity and glucose intolerance is increased. The condition is worsened by diabetes, alcoholism, and hypothyroidism. Risk factors are a family history of high cholesterol and early coronary artery disease. The incidence is 2 out of 1000 people.

Prevention: A low-cholesterol, low-saturated fat diet in high risk individuals may help to control LDL levels. Screening of family members of people with familial combined hyperlipidemia should be undertaken to facilitate early treatment. Sometimes younger children may have mild hyperlipidemia.

Symptoms:

• obesity may coexist

Signs and Tests:

• elevates serum LDL
• elevated total cholesterol
• decreased or normal serum HDL cholesterol
• elevated triglycerides
• elevated apolipoprotein B100 test

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

Diet modification is the initial phase of treatment and is tried for several months before drug therapy is added. Diet modifications include reducing total fat intake to 30% of the total calories consumed. Saturated fat intake is reduced by decreasing the amounts of beef, chicken, pork, and lamb; substituting low-fat dairy products; and eliminating coconut and palm oil. Cholesterol intake is reduced by eliminating egg yolks and organ meats. Further reductions in the percentage of fat in the diet may be recommended after the initial trial period. Dietary counseling is often recommended to assist people with these adjustments to their eating habits. Weight loss and regular exercise may also aid in lowering cholesterol levels.

Drug therapy may be initiated if diet, exercise, and weight reduction efforts have not reduced the cholesterol levels after an adequate trial period. Various cholesterol reducing agents are available including:

• bile acid sequestrant resins (cholestyramine and colestipol)
• nicotinic acid
• lovastatin
• gemfibrozil
• probucol

Prognosis: The probable outcome is related to early diagnosis and treatment and compliance with therapy.

Complications: A complication is early atherosclerotic heart disease or myocardial tissue death due to lack of blood (infarction).

Call your health care provider if you experience warning symptoms of myocardial infarction or your screening total cholesterol was found to be high.