Mixed hyperlipidaemia

This is defined as TC >5 and fasting triglycerides >1.7, which strikes me as including practically everyone.  Secondary causes include:

Diabetes (if the triglycerides are >3, then there’s about a 10% chance it’s diabetes and 30% chance of IGT – in that case, check an HbA1c or GTT even if the fasting glucose is normal).

Excess alcohol

Liver disease (obstructive or parenchymal).

Severe renal impairement – 90% of patients with CKD 4 will have hypertriglyceridaemia.

Thyroid dysfunction, though unlikely – much more likely to cause pure hypercholesterolaemia.

Rare causes include medication, Cushing’s syndrome, anterior pituitary deficiency, and PCOS.

Also remember to look for the metabolic syndrome – waist circumference >95 cm for white people or >88 cm for Asians (it doesn’t say what the cut-off is for black people), plus two out of four others:

  • Triglycerides >2.3
  • HDL <1.0 in men or 1.2 in women
  • Systolic BP >130
  • Fasting glucose >5.5

So, if triglycerides are over 1.7, ask about alcohol intake and check LFTs, U&Es, and fasting glucose.  If they’re over 2.3, check systolic BP and waist circumference as well.

(From an article in the BMJ, 3rd September)


About Dr Sarah

I'm a GP with a husband and two young children.
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