Treatment. Therapy choices differ depending on the type of mixed hyperlipidemia a patient has. However, fibrates are usually needed in addition to statins. (Of note: Statin-induced myopathy is more likely in patients who are also taking fibrates, so careful monitoring is important.)
I added fenofibrate, metformin, and rosuvastatin to the patient’s regimen, which included ramipril, glyburide, and hydrochlorothiazide. I also recommended lifestyle modifications and arranged a consultation with a dietician.
Four weeks later, his fasting lipid profile had improved: Total serum cholesterol level was 213.45 mg/dL, triglyceride level was 825.5 mg/dL, and HDL-C level was 37.05 mg/dL. Apolipoprotein B100 was 2.54 g/L (normal=0.59-1.46 g/L). At follow-up 3 months later, the patient’s total cholesterol level was 145.9 mg/dL, triglyceride level was 330.4 mg/dL, and HDL-C level was 27.84 mg/dL.
CORRESPONDENCE H.U. Rehman, MB, Clinical Associate Professor, Department of Medicine, Regina Qu’Appelle Health Region, Regina General Hospital, 1440 14th Avenue, Regina, SK, S4P 0W5, Canada; habib31@sasktel.net