Mixed hyperlipidemia, also known as familial combined hyperlipidemia, is an inherited condition in which levels of certain lipids (fats) in the blood are higher than they should be.
Elevated levels of low-density lipoproteins (LDL or “bad” cholesterol) and triglycerides are risk factors for cardiovascular disease. Mixed hyperlipidemia may also include lower-than-normal levels of high-density lipoprotein (HDL or “good” cholesterol).
One of the challenges in managing mixed hyperlipidemia is that it can sometimes be present without obvious symptoms.
Read on to learn more about mixed hyperlipidemia symptoms, the risk factors, and when to see your doctor about getting your cholesterol levels checked.
Though mixed hyperlipidemia is a genetic condition and therefore present at birth, you could live for many years without any noticeable symptoms. Even high levels of LDL cholesterol and triglycerides may not be revealed on blood tests until your 20s or 30s.
When symptoms develop, they’re usually indications of atherosclerosis, or a narrowing of the arteries caused by a buildup of plaque along the arterial walls.
This plaque, which is made up of cholesterol, fats, and other substances, causes the arteries to become less flexible. This makes it harder for blood to flow through the arteries properly.
Symptoms of mixed hyperlipidemia can include:
- angina (chest pain) caused by reduced blood flow to the heart muscle
- leg cramps caused by narrowed arteries in the calves
- sores that don’t heal on the feet or lower legs
When to get immediate medical attention
The most serious complications of mixed hyperlipidemia are heart attack and stroke, so it’s important to recognize the early symptoms of these events so you can get emergency help right away.
Common heart attack symptoms include:
- chest pain, sometimes described as tightness or pressure
- pain in one or both arms, or in the neck, jaw, or shoulders
- shortness of breath
Stroke symptoms include:
- face drooping on one side
- speech difficulty
- sudden confusion
- sudden, severe headache
- sudden loss of balance
- tingling or numb sensation in the limbs (usually on one side)
A blood test can reveal your lipid levels. If your lipid levels are outside the healthy range — especially if you’re under the age of 40 — further diagnosis may be needed.
For example, your doctor may ask whether anyone in your family had hyperlipidemia or cardiovascular disease at a young age.
Concerning levels of LDL, HDL, and triglycerides include:
- HDL: lower than 40 mg/dL
- LDL: higher than 100 mg/dL
- Triglycerides: higher than 150 mg/dL
What to know about cholesterol measurements
A standard cholesterol test, known as a lipid panel, involves a blood draw. It checks your levels of:
- LDL (bad) cholesterol: low-density lipoproteins that can build up in your bloodstream and block arteries and blood vessels
- HDL (good) cholesterol: high-density lipoproteins that help remove “bad” cholesterol from your blood
- Triglycerides: a type of fat in your blood that stores calories you don’t use
- Total cholesterol: the sum of your HDL and LDL cholesterol plus 20% of triglycerides in your bloodstream
There is still no definitive genetic test that can confirm a diagnosis of mixed hyperlipidemia.
Having a certain type of
- Ashkenazi Jewish
- French Canadian
The goal of treatment is to lower LDL cholesterol and triglycerides to a normal or healthy range to reduce the risk of atherosclerosis and cardiovascular disease.
Your doctor will probably recommend important lifestyle changes, such as:
- exercising most days of the week
- following a heart-healthy diet, such as the Mediterranean diet
- maintaining a moderate body weight
- quitting smoking, if you smoke
Depending on your lipid levels, as well as your age and overall health, your doctor may prescribe an LDL-lowering medication, such as a statin. Other lipid-lowering medications include PCSK9 inhibitors and ezetimibe.
As such, people with high levels of both blood fats need more aggressive lipid-lowering treatment.
Because mixed hyperlipidemia is an inherited condition, it can’t be prevented. However, early diagnosis and sticking to an effective treatment plan may help prevent serious complications.
One of the most important steps you can take to keep mixed hyperlipidemia from causing severe complications is to have your blood lipid levels checked regularly.
Mixed hyperlipidemia doesn’t usually have obvious symptoms. If cholesterol plaques develop and affect your blood vessels and blood flow, you may start to experience chest pain, leg pain, or other symptoms.
To prevent complications from mixed hyperlipidemia, make sure you’re aware of your family history and have your lipid profile checked regularly.
Although mixed hyperlipidemia currently has no cure, aggressive and lifelong treatment can often bring lipid levels under control.