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Mixed Hyperlipidemia

What is mixed hyperlipidemia?

Mixed hyperlipidemia is a genetic disorder passed down through family members. If you have this disease, it means you have higher-than-normal levels of cholesterol, triglycerides, and other lipids in your blood. The disorder contributes to heart disease and early heart attacks. Diabetes, hypothyroidism, obesity, and alcohol abuse can make the condition worse.

Mixed hyperlipidemia is also known as familial combined hyperlipidemia. It affects an estimated 1 to 2 percent of the population in the Western world. In fact, it's the most common inherited lipid disorder. The high lipid levels typically begin in your teenage years. Some evidence shows that hyperlipidemia begins in childhood for some people.

Learn more about this condition, including causes, risks, and what to expect from treatment.

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Causes

Causes of mixed hyperlipidemia

Scientific research is ongoing into the specific genes that cause this disorder. The research is complex because the characteristics of mixed hyperlipidemia overlap with those of metabolic syndrome. This syndrome isn’t genetically determined and is more widespread. But new statistical and genetic research techniques are helping scientists understand the causes of mixed hyperlipidemia.

If one of your parents has mixed hyperlipidemia, you have a 50 percent chance of inheriting the genetic risk of the disorder, according to a Kaiser Permanente report. And if both your parents have it, you might inherit a double dose, which can cause more serious medical problems earlier in life.

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Risks

Risks and risk factors

Mixed hyperlipidemia is inherited and causes high lipid levels. Your lipid levels will be even higher if you also have conditions such as:

  • diabetes
  • hypothyroidism
  • obesity
  • alcohol abuse

These high lipid levels from mixed hyperlipidemia put you at risk of:

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Diagnosis

Diagnosing mixed hyperlipidemia

Mixed hyperlipidemia is usually first noticed when blood tests indicate high lipid levels. You may not have any physical symptoms. But knowing your family history, especially of heart disease or hyperlipidemia, will help your doctor make a diagnosis.

How common is it?
• About 1 to 2 percent of the population in Western countries have mixed hyperlipidemia, according to a conservative estimate.
• About 10 percent of people with heart disease have mixed hyperlipidemia.
• In the United States, it affects 2.7 million people.
• It’s estimated to cause between 30,000 and 70,000 heart attacks per year.

Genetic research is progressing. Medical professionals may someday develop a genetic test for mixed hyperlipidemia and a treatment that targets the genes involved.

Currently, though, your doctor will need to perform a blood test to make a diagnosis. The test determines the levels of lipids in your blood. Your doctor will look for:

  • lower-than-average HDL cholesterol levels
  • higher levels of LDL cholesterol, triglycerides, and apolipoprotein B100

These results may indicate mixed hyperlipidemia.

The blood test requires fasting for 12 hours before the test. That means you can’t eat or drink anything except water. Your doctor will also ask you about any drugs and supplements you usually take. They’ll tell you whether or not to take these before the test.

Some doctors may use a carotid ultrasound as a diagnostic tool. It’s not expensive or invasive. Plus, it can help predict future heart attacks or stroke.

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Treatment

Treatment

Mixed hyperlipidemia is an inherited disorder with no cure. The goal of treatment is to reduce your risk of heart disease and its complications. Your treatment plan will depend on your age at diagnosis, how high your lipid levels are, and whether you have any symptoms, such as chest pain.

The first step in treatment is making some lifestyle changes. You doctor may also prescribe medications.

Lifestyle changes

For many people, lifestyle changes alone can help reduce cholesterol and triglyceride levels.

To help reduce your risk of heart disease, your doctor may suggest a low-fat diet, weight loss, and regular exercise. A low-fat diet can lessen your risk of heart disease, according to the American Heart Association. Evidence also suggests that cutting out sugar and reducing carbohydrates is effective in lowering both your weight and triglycerides while increasing HDL.

To manage your cholesterol, try these tips:

Stop smoking: Smoking increases the risk of heart disease.

Lose weight: If necessary, see a dietician for help selecting a healthy diet or join a weight-loss group like Weight Watchers.

Get moving: If you're not physically active, start off with 15 minutes of moderate exercise per day. A recommended goal is at least 30 minutes of exercise per day, even if it's split into 10-minute segments. Find something that you like to do. It could be walking, swimming, biking, dancing, a gym workout, or something else. The most important thing is to find a routine that you'll stick to.

Keep to a healthy diet: Limit fast foods and maximize fresh foods. Incorporate more fish in your diet. Try a Mediterranean-style diet. There are many resources that can help you plan healthy menus that work with your lifestyle.

Medication

If your cholesterol levels remain high after lifestyle changes, your doctor may prescribe medication. There are several drugs that can help. Each works differently to change your cholesterol levels. They may include:

Statins: These are usually a first-line treatment. These drugs block the substance your liver uses to make cholesterol. Your doctor may also recommend an omega-3 fatty acid supplement.

Bile-acid-binding resins: These are drugs that get the liver to make more bile acids. These then reduce the cholesterol in your blood.

Cholesterol absorption inhibitors: These drugs limit the amount of dietary cholesterol you absorb.

Injectable drugs: Certain injectable medication can help the liver lower the cholesterol level in your blood.

You may have side effects from a particular drug or combination of drugs. For instance, some people can’t tolerate statins. If this is the case, your doctor will work with you to find another drug option.

Your doctor will monitor your treatment progress with regular lab tests. They may also want to monitor the effect of the medications on your liver function.

New information about treatment is still coming out. If you have mixed hyperlipidemia, check with your doctor regularly about research updates.

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Outlook

What can I expect?

Your outlook depends on how early you were diagnosed, how you respond to the prescribed treatment plan, and how well you stick to the plan. If left untreated, mixed hyperlipidemia puts you at high risk of an early heart attack or stroke. But with lifestyle changes and medication, your lipid levels should improve.

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