From the Guidelines
Mixed dyslipidemia is a condition characterized by abnormal levels of multiple lipid components in the blood simultaneously, involving elevated levels of triglycerides and low-density lipoprotein (LDL) cholesterol, along with decreased levels of high-density lipoprotein (HDL) cholesterol. This lipid disorder is particularly common in patients with metabolic syndrome, type 2 diabetes, and obesity, as noted in studies such as 1. The condition significantly increases the risk of cardiovascular disease as these lipid abnormalities work synergistically to accelerate atherosclerosis.
Key Characteristics and Risks
- Elevated triglycerides
- High LDL cholesterol
- Low HDL cholesterol
- Increased risk of cardiovascular disease
- Common in patients with metabolic syndrome, type 2 diabetes, and obesity
Treatment Approach
Treatment typically involves lifestyle modifications including a heart-healthy diet low in saturated fats and simple carbohydrates, regular physical activity, weight management, and smoking cessation, as recommended by guidelines such as those outlined in 1 and 1. When lifestyle changes are insufficient, medication therapy is often necessary. Statins are usually the first-line treatment, such as atorvastatin 10-80 mg or rosuvastatin 5-40 mg daily, but combination therapy may be required. Additional medications might include fibrates (like fenofibrate 145 mg daily), niacin, or ezetimibe 10 mg daily.
Pathophysiology and Management
The underlying pathophysiology involves insulin resistance, which increases free fatty acid flux to the liver, promoting triglyceride synthesis and secretion of very low-density lipoprotein (VLDL), ultimately resulting in the characteristic lipid profile abnormalities, as discussed in 1. Improved glycemic control can be very effective for reducing triglyceride levels and should be aggressively pursued, along with lifestyle modifications and, when necessary, pharmacological interventions, as outlined in 1.
From the FDA Drug Label
Fenofibrate tablets are indicated as adjunctive therapy to diet to reduce elevated low-density lipoprotein cholesterol (LDL-C), total cholesterol (Total-C), Triglycerides and apolipoprotein B (Apo B), and to increase high-density lipoprotein cholesterol (HDL-C) in adult patients with primary hypercholesterolemia or mixed dyslipidemia.
Mixed dyslipidemia is a condition characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (Total-C), and triglycerides, as well as decreased levels of high-density lipoprotein cholesterol (HDL-C) 2.
- Key features of mixed dyslipidemia include:
- Elevated LDL-C
- Elevated Total-C
- Elevated triglycerides
- Decreased HDL-C
- Treatment for mixed dyslipidemia typically involves adjunctive therapy to diet, such as fenofibrate tablets, to reduce lipid levels and increase HDL-C 2.
From the Research
Definition of Mixed Dyslipidemia
- Mixed dyslipidemia is characterized by low levels of high-density lipoprotein cholesterol and elevated levels of triglycerides, with or without elevated levels of low-density lipoprotein cholesterol (LDL-C) 3.
- It is also referred to as atherogenic dyslipidemia, which is a complex dyslipidemia defined as the coexistence of fasting hypertriglyceridemia and low high-density lipoprotein cholesterol level 4.
- This condition is often comorbid with hyperglycemia in patients with type 2 diabetes mellitus (T2DM), namely that associated with obesity, insulin resistance, hyperinsulinemia, and the metabolic syndrome phenotype 4.
Characteristics of Mixed Dyslipidemia
- Elevated triglycerides and low high-density lipoprotein cholesterol level are markers of very high risk in type 2 diabetes 4.
- The presence of atherogenic dyslipidemia markedly increases cardiovascular risk, and there is evidence that part of the residual cardiovascular risk in T2DM can be safely and effectively reduced by fibrates 4.
- The triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio has been proposed as a novel biomarker for predicting the risk of metabolic syndrome and cardiovascular disease 5.
Management of Mixed Dyslipidemia
- National guidelines recommend the addition of either niacin or a fibrate to statin therapy in patients with mixed dyslipidemia to achieve better overall lipid control 3.
- Fibrates do not have detrimental effects on uric acid levels or glycemic control in patients with diabetes or the metabolic syndrome 3.
- The addition of fenofibrate to statin therapy may be a useful strategy for the management of mixed dyslipidemia in patients with or at risk for cardiovascular disease 3.