Practice Rational Testing

Investigating mixed hyperlipidaemia

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5146 (Published 25 August 2011) Cite this as: BMJ 2011;343:d5146
  1. Adie Viljoen, consultant chemical pathologist1,
  2. Anthony S Wierzbicki, consultant metabolic physician, chemical pathologist, honorary reader in lipids and cardiometabolic disease2
  1. 1Lister Hospital, Stevenage SG1 4AB, UK
  2. 2Guy’s & St Thomas’ NHS Trust, St Thomas’ Hospital, London SE1 7EH, UK
  1. Correspondence to: Dr A S Wierzbicki, Department of Chemical Pathology, St Thomas’ Hospital, London SE1 7EH Anthony.Wierzbicki{at}kcl.ac.uk

Mixed hyperlipidaemia is often associated with metabolic syndrome, non-alcoholic fatty liver disease, and risk of developing type 2 diabetes

Learning points

  • Mixed hyperlipidaemia (defined as fasting triglyceride >1.7 mmol/L and total cholesterol >5 mmol/L) is often associated with lifestyle factors such as excess alcohol or obesity

  • Mixed hyperlipidaemia is a feature of the metabolic syndrome and associated with non-alcoholic fatty liver disease and risk of developing type 2 diabetes

  • It may also be a marker of endocrine disease (such as polycystic ovary syndrome) or hepatic disease

  • It is associated with increase in cardiovascular risk not fully captured by commonly used risk calculators

A 50 year old white man visited his general practitioner after the recent death of his brother from a myocardial infarction at the age of 63. Apart from a single gout attack, his medical history was unremarkable. He was taking no medications, denied excess alcohol intake, and was a former smoker (of 20 cigarettes a day), having stopped about seven years ago. He was centrally obese with a body mass index of 34 (weight(kg)/(height (m)2)) and a waist circumference of 107 cm and height 176 cm. His blood pressure was 144/94 mm Hg. His fasting lipid profile was total cholesterol 6.6 mmol/L, triglycerides 5.1 mmol/L, high density lipoprotein cholesterol 1.1 mmol/L; calculation of low density lipoprotein cholesterol was not possible owing to high triglyceride levels. His fasting glucose was 6.3 mmol/L.

What is the next investigation?

Mixed hyperlipidaemia is defined as fasting triglyceride >1.7 mmol/L and total cholesterol as >5 mmol/L (as in this case). Diagnosis of mixed hyperlipidaemia is important because of its associations with increased cardiovascular risk, its strong association with risk of diabetes, and its role as an ancillary liver function test. Guidelines from the National Institute for Health and Clinical Excellence …

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