Mixed Dyslipidemia: Treatment, Procedure, Cost and Side Effects

Mixed dyslipidemia is lipoprotein metabolism disorder, including either lipoprotein deficiency or overproduction. The manifestation of dyslipidemia is caused due to build-up of the total cholesterol, triglyceride concentrations, the ‘’bad’’ low-density lipoprotein (LDL) cholesterol and a reduction in the ‘’good’’ high-density lipoprotein (HDL) cholesterol elevation in the blood.

An important class of drugs known as Fibrates is an important source of managing mixed dyslipedemia. This is generally a well tolerated class but is rarely in association with multiple safety issues. Fibrates, most likely may reversibly increase homocysteine and creatinine via a process arbitrated by peroxisome proliferator-activated receptor-alpha, with an increase in the risk for renal failure in clinical trials. Fibrate-statin therapy can stimulate reductions in TGs and LDL-C and at the same time increases in HDL-C. Fibrates are in association with a slight growth in the risk (<1.0%) for venous thrombosis, cholelithiasis, and myopathy. Fibrates are also associated with a growth in noncardiovascular mortality in clinical trials. The combination of statins and gemfibrozil is generally avoided. Statin-niacin mixed therapy is considered useful in case of residual cardiovascular risk. Most often, statin is added to niacin in patients undergoing combined hyperlipidemia, especially if lipoprotein is high or HDL is low. Although there has been a reduction of 30% in CHD events as demonstrated by a study, combination therapy of statin and niacin has resulted in a 75% reduction.

Clinicians are supposed to measure the serum creatinine levels before the use of fibrate and adjust the dosage accordingly. It is not a requirement to monitor the creatinine, but if there is an exclusion of potential causes of creatinine increase or a clinically important increase in a patient, there must be a consideration to either reduce the dose or discontinue fibrate therapy. The additive effects of fenofibrate and simvastatin on lipid parameters have been saved in the trial called Simvastatin Plus Fenofibrate for Combined Hyperlipidemia (SAFARI). Combination therapy of fenofibrate 160 mg/day plus simvastatin 20 mg/day was compared with monotherapy of simvastatin 20 mg/day in patients with mixed dyslipidemia. In comparison with monotherapy, there was a significant decrease in LDL levels with combination therapy (25.8% and 31.2%, respectively). In addition, when compared to monotherapy HDL-C levels increased in case of combination therapy (9.7% and 18.6%, respectively). No serious occurrence of any adverse events related to drugs was noticed.

The combination of statin-niacin therapy has also proven beneficial for mixed dyslipidemia. The addition of 1000 mg/day of niacin to existing statin therapy was in accordance with a decrease in growth of carotid intimal media thickness. Also, the therapy of niacin (2-4 g/day) plus simvastatin (10-20 mg/day) found out to cause a significant reduction of 90% in the risk for composite cardiovascular endpoints (coronary causes leading to death, revascularization, or confirmed stroke or myocardial infarction). This generally happened in groups treated with niacin and simvastatin compared with placebo (P=.03).

Women who are not expecting and people who don’t have an underlying medical condition are eligible for the treatment. People with total cholesterol levels of 3.0-6.5 mmol/L with no clear symptom for liquid-modifying therapy are also included.

Pregnant women and children are not eligible for the treatment.

The side effects of the treatment include stomach ache, tenderness, dark urine, jaundice, persistent vomiting, fever and weakness.

Quit smoking as it will directly increase your bad cholesterol level. Intake of niacin (1,500 md/day) will reduce LDL cholesterol by 25% and will increase good cholesterol by 35%. Moderate exercise including swimming and walking is recommended by the doctor. Return to the normal exercise routine is extremely beneficial. A healthy, low-fat, nutritional and balanced diet with plenty of vegetables, fruits and fibre is extremely good for a patient’s general health. In case you are on medications for mixed dyslipidemia, avoiding or limiting the amount of alcohol is necessary. Keep checking with your doctor to have assurance regarding your condition. Do not read books and articles, or take advices on diets that usually claim to cure mixed dyslipidemia. Most people don’t benefit from these different and confusing recommendations. An unusual diet will cause more harm than good. Counseling sessions with your doctor may also help you to a great extent.

There must be some lifestyle changes for a considerable result. The benefits of certain lifestyle modifications become evident between 6-12 months.

The cost of medication in India is from Rs. 1,000 to Rs. 5,000.

No the results of the treatment are not permanent as the cholesterol levels may rise again if the lifestyle of a person is not modified.

A diet full of inflammatory food items has the possibility to increase the risk for dyslipidemia or can worsen the condition. So make sure you have anti-inflammatory food items and limit the consumption of harmful processed foods. Food items that contain too much alcohol, caffeine, hydrogenated fats, trans fat and sugar should be avoided at all costs. Foods containing omega-3 fats, olive oil, garlic, onions, and high soluble fiber will heal this condition.