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Combined hyperlipidemia
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{{More citations needed|date=May 2009}} {{Infobox medical condition (new) | name = Combined hyperlipidemia | synonyms = '''Multiple-type hyperlipoproteinemia''' | image = Autosomal dominant - en.svg | alt = | caption = Combined hyperlipidemia is inherited in an autosomal dominant manner. | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Combined hyperlipidemia''' (or -aemia) is a commonly occurring form of [[hypercholesterolemia]] (elevated [[cholesterol]] levels) characterised by increased [[Low-density lipoprotein|LDL]] and [[triglyceride]] concentrations, often accompanied by decreased [[High density lipoprotein|HDL]].<ref name="Andrews">{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}</ref>{{Rp|534|date=May 2009}} On lipoprotein [[electrophoresis]] (a test now rarely performed) it shows as a [[hyperlipoproteinemia type II]]B. It is the most commonly inherited lipid disorder, occurring in around one in 200 persons. In fact, almost one in five individuals who develop [[coronary heart disease]] before the age of 60 have this disorder. The elevated [[triglyceride]] levels (>5 [[mmol]]/[[litre|L]]) are generally due to an increase in very low density lipoprotein ([[VLDL]]), a class of [[lipoprotein]]s prone to cause [[atherosclerosis]]. ==Cause== Hereditary factors are the most common cause. A diet high in saturated fat and cholesterol increases blood cholesterol and triglyceride levels. Other disorders, such as diabetes mellitus, kidney disease, and hypothyroidism, may promote hypertriglyceridemia. Certain drugs, such as [[estrogen]], [[corticosteroid]]s, [[retinoid]]s, [[protease inhibitor (pharmacology)|protease inhibitor]]s, [[thiazide diuretic]]s, and [[beta-blocker]]s, may cause [[hypertriglyceridemia]]. [[Obesity]] increases the risk of hyperlipidemia. Chronic, [[Alcohol use disorder|excessive alcohol use]] increases the risk of hypertriglyceridemia. [[Tobacco smoking|Smoking]] and not [[Physical exercise|exercising]] may lead to hyperlipidemia. Steroid uses, alcoholism, [[hypothyroidism]], oral contraceptives, chronic [[kidney failure]], [[hypopituitarism]], and nephritic syndrome are other contributors to hyperlipidemia. ==Diagnosis== === Types === The two forms of this [[lipid]] disorder are: * Familial combined hyperlipidemia (FCH) is the familial occurrence of this disorder, probably caused by decreased LDL receptor and increased ApoB. * Acquired combined hyperlipidemia is extremely common in patients who have other diseases from the [[metabolic syndrome]] ("syndrome X", incorporating [[diabetes mellitus type II]], [[hypertension]], [[central obesity]] and CH). Excessive [[free fatty acid]] production by various tissues leads to increased VLDL synthesis by the [[liver]]. Initially, most VLDL is converted into LDL until this mechanism is saturated, after which VLDL levels elevate. == Treatment == Both conditions are treated with [[fibrate]] drugs, which act on the [[peroxisome proliferator-activated receptor]]s (PPARs), specifically PPARα, to decrease free fatty acid production. [[Statin]] drugs, especially the synthetic statins ([[atorvastatin]] and [[rosuvastatin]]), can decrease LDL levels by increasing hepatic reuptake of LDL due to increased LDL-receptor expression. == See also == {{Portal|Medicine}} <!-- alphabetical order please [[WP:SEEALSO]] --> <!-- please add a short description [[WP:SEEALSO]], via {{subst:AnnotatedListOfLinks}} or {{Annotated link}} --> {{div col|colwidth=40em|small=yes}} * {{Annotated link |Hyperlipidemia}} {{div col end}} <!-- alphabetical order please [[WP:SEEALSO]] --> == References == {{reflist}} == External links == {{Medical resources | ICD10 = {{ICD10|E|78|4|e|70}} | ICD9 = {{ICD9|272.4}} | DiseasesDB = | OMIM = 144250 | MedlinePlus = 000396 | eMedicineSubj = | eMedicineTopic = | MeshID = }} {{Lipidemias}} {{DEFAULTSORT:Combined Hyperlipidemia}} [[Category:Lipid disorders]] [[Category:Medical conditions related to obesity]] [[Category:Skin conditions resulting from errors in metabolism]]
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