The Diagnosis and Management of Lipoprotein Disorders
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Severe hypertriglyceridemia (triglyceride values > 1000 mg/dL) is occasionally observed in middle-aged or elderly individuals who are obese and have glucose intolerance and hyperuricemia. These subjects usually have familial hypertriglyceridemia or familial combined hyperlipidemia that is exacerbated by other factors, such as obesity and diabetes mellitus. These patients generally also have HDL cholesterol deficiency and may develop lipemia retinalis and eruptive xanthomas. They are at increased risk for developing pancreatitis owing to triglyceride deposition in the pancreas and may have paresthesias and emotional lability. These patients often have delayed chylomicron and VLDL cholesterol clearance and excess VLDL production. Treatment consists of a calorie-restricted step 2 diet. In patients with diabetes mellitus, blood glucose is controlled as tightly as possible. Medications that are effective in lowering the triglycerides to less than 1000 mg/dL in these patients, to reduce their risk of pancreatitis, include gemfibrozil or fish oil capsules (six to ten capsules per day).
Lipoprotein Metabolism and Implications for Atherosclerosis Risk Determination and Treatment Decisions
P. K. Shah in Risk Factors in Coronary Artery Disease, 2006
The combination of elevated triglycerides and elevated LDL-C is termed combined hyperlipidemia, and when a family history of hyperlipidemia or atherosclerosis is present, it is termed familial combined hyperlipidemia (FCH). FCH is associated with a four-fold increased CAD risk (101,102). The variability in phenotypic expression has involved a number of related disorders, including LDL subclass pattern B, hyperapobetalipoproteinemia, familial dyslipidemic hypertension, and syndrome X (103–106). One attribute of FCH involves LDL particles more susceptible to oxidative damage than LDLs from non-FCH individuals (107,108).
Identification and Management of Children with Dyslipidemia
James M. Rippe in Lifestyle Medicine, 2019
Another common cause of hypercholesterolemia is familial combined hyperlipidemia (FCHL) or type IIb hyperlipoproteinemia (Table 79.5). This is an autosomal dominant genetic disorder that is the most common genetic lipid disorder in the United States, affecting approximately 1 in 200 people. There is phenotypic variation among family members with FCHL, with the most common lipid phenotype showing elevated LDL-C with elevated TGs and very-low-density lipoprotein cholesterol (VLDL-C), and low HDL-C. FCHL may also be seen in those with overweight, insulin resistance, and hypertension.
Identifying suspected familial chylomicronemia syndrome
Published in Baylor University Medical Center Proceedings, 2018
Ronak Rengarajan, Peter A. McCullough, Anima Chowdhury, Kristen M. Tecson
Because the goal of this study was to identify a rare disorder, the adjudication panel focused on ruling out patients, which required clear evidence that pancreatitis or high triglycerides was caused by a secondary factor (e.g., hypothyroidism, medications, alcohol abuse, uncontrolled diabetes).11 Although diabetes has been used to rule out FCS in some algorithms, recurrent pancreatitis may lead to endocrine/exocrine insufficiency, and impaired energy metabolism related to LPL dysfunction may occur from FCS, which could cause diabetes.12 For that reason, the diagnostic algorithm in this study did not rule patients out based on diabetes. Stroes et al introduced the triglyceride/total cholesterol ratio ≥5 as a diagnostic aid, a threshold that approximately 75% of our patients reached.3 Because a variety of lipid disorders yield high triglyceride values, ensuring apolipoprotein B < 120 mg/dL is advised to eliminate the most common diagnosis, polygenic combined hyperlipidemia; however, only one of our cases had an apolipoprotein B measure.3
Characteristics of patients with dyslipidemia treated in routine care setting in China
Published in Journal of Drug Assessment, 2019
Gordon Liu, Jason Shepherd, Pratik Rane, Zhongyun Zhao, Hollie Bailey, Nathan Williams, Yi Qian
This study included 195 physicians (40 endocrinologists, 75 internists, 80 cardiologists) who provided data on 1870 patients of whom 852 had been diagnosed with diabetes by the time of the survey. All patients completed the patient survey. Characteristics of study patients at diagnosis are provided in Table 1. Compared with non-diabetic patients (n = −1,018), individuals with diabetes (n = 852) were older on average (p < 0.0001) and a greater percentage of diabetic patients were retired or had a caregiver (p < .0001, p < .005, respectively). Among diabetic patients, 47% had been diagnosed with combined hyperlipidemia (hypercholesterolemia/hypertriglyceridemia) compared with 39% of patients without diabetes (p < .001). This finding was reversed for the diagnosis of hypercholesterolemia alone (p < .0050). Similar percentages of patients with and without diabetes carried a diagnosis of hypertriglyceridemia and familial combined hyperlipidemia (p > .6).
Benefits and risks of the treatment with fibrates––a comprehensive summary
Published in Expert Review of Clinical Pharmacology, 2018
Bogusław Okopień, Łukasz Bułdak, Aleksandra Bołdys
Fibrates are the most effective drugs in the therapy of hypertriglyceridemia and are the treatment of choice in severe hypertriglyceridemia [1]. The unique benefit of fibrate therapy is its strong impact on postprandial/non-fasting hypertriglyceridemia, which is considered as one of the novel cardiovascular risk factors. Due to above-mentioned increased LPL activity, the postprandial rise in the level of highly atherogenic remnant lipoprotein level may be prevented [42]. According to a large-scale meta-analysis (examining data from 16,802 patients and 53 trials) the TG decrease during treatment reached 36%, varying between 18% for clofibrate and 48% for gemfibrozil [43]. Impact of fibrates on LDL-C reduction is less prominent than on TG and averages around 11%, but these drugs have unique ability to significantly increase HDL-C by 10% [43]. These features are ideal to treat patients with atherogenic dyslipidemia [4]. What is more, they are very effective in patients with combined hyperlipidemia [44]. In this setting 200 mg per day of fenofibrate was superior to 10 mg of atorvastatin in TG reducing potential (28% vs. 12%; p < 0.001) and was similarly effective in LDL-C reduction (−18.9% vs. 24.9%; p > 0.05). Recently, several studies on the combination therapy with fibrates and ezetimibe have also been performed. EFECTL Study showed benefits of combined treatment with fenofibrate and ezetimibe compared to both monotherapies in patients with combined hyperlipidemia [45]. A specific additive effect of combined treatment was clearly noted in the magnitude of LDL-C reduction that reached
Related Knowledge Centers
- Coronary Artery Disease
- Hyperlipidemia
- Triglyceride
- Hypercholesterolemia
- Cholesterol
- Low-Density Lipoprotein
- High-Density Lipoprotein
- Electrophoresis
- Very Low-Density Lipoprotein
- Lipoprotein