Familial combined hyperlidemia patients are initially asymptomatic, but need to monitor body weight [1] and waist- to- hip ratio [2] in order to avoid abdominal obesity, that seems to be related to lipid profile modification. These parameters are also in relation with other biochemical abnormalities: decreased leptin and adiponectin [3] and high insulin resistance [4]. Same principles apply to children who come from affected parents, who need to maintain body weight within normal range.

Signs of hepatic suffering may be encountered in the context of fatty liver and non-alcoholic steatohepatitis [5], but they are not specific for familial combined hyperlidemia. Clinical examination is noncontributory in some cases, because xanthoma are almost never present in this disease [6].

Patients may also suffer form arterial hypertension [7], which further increases cardiovascular risk.

• Pain

  Severely restricted blood flow in the heart muscle leads to symptoms such as chest pain. For a healthy diet, replace unhealthy and fattening foods with healthier alternatives, such as fresh fruits and vegetables. [mountsinai.org]

  Complications may include: Early atherosclerotic heart disease Heart attack Stroke Seek medical care right away if you have chest pain or other warning signs of a heart attack. [medlineplus.gov]

  When symptoms appear, they may include: Chest pain (angina) or other signs of coronary artery disease may be present at a young age. Cramping of one or both calves when walking. Sores on the toes that do not heal. [stlukes-stl.com]

• Asymptomatic

  INTRODUCTION: The aim of this study was to evaluate the plasma levels of endothelial haemostatic markers - von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA) and soluble thrombomodulin (sTM) - in asymptomatic [ncbi.nlm.nih.gov]

  Patients are usually asymptomatic during childhood, although biochemical abnormalities are present at a young age, but have significant cardiovascular disease as they grow older. [symptoma.com]

• Coronary Atherosclerosis

  atherosclerosis. [ PMID 18303204 ] Body mass index is associated with USF1 haplotype in Korean premenopausal women. [ PMID 18445538 ] Upstream transcription factor 1 (USF1) in risk of type 2 diabetes: association study in 2000 Dutch Caucasians. [ PMID [snpedia.com]

  atherosclerosis. remnant hyperlipidemia a form in which the accumulated lipoproteins are normally transient intermediates, chylomicron remnants, and intermediate-density lipoproteins; a generic descriptor for the type III hyperlipoproteinemia phenotype [medical-dictionary.thefreedictionary.com]

  Association of coronary atherosclerosis with hyperapobetalipoproteinemia [increased protein but normal cholesterol levels in human plasma low density (beta) lipoproteins]. Proc Natl Acad Sci U S A. 1980; 77 : 604–608. [ahajournals.org]

  Effects of fluvastatin on coronary atherosclerosis in patients with mild to moderate cholesterol elevations (Lipoprotein and Coronary Atherosclerosis Study [LCAS]). Am J Cardiol. 1997;80:278–86. 15. [aafp.org]

• Flatulence

  Common side effects of resins include constipation, abdominal pain, bloating, nausea, and flatulence. [unboundmedicine.com]

  Gastrointestinal disturbances are common and include constipation, nausea, indigestion, bloating, diarrhea and flatulence. [aafp.org]

• Heart Disease

  disease (heart attacks) The main goal in treating individuals with FCH is to decrease the occurrence of early coronary heart disease. [dovemed.com]

  PURPOSE OF REVIEW: To provide an overview of recent advances that have defined the first putative genes behind familial combined hyperlipidemia, the most common genetic dyslipidemia and a major risk factor for early coronary heart disease. [ncbi.nlm.nih.gov]

  See also: Heart disease and diet MEDICATIONS If lifestyle changes do not change your cholesterol levels, or you are at very high risk of developing atherosclerotic heart disease, your doctor may recommend medication. [kentuckyonehealth.org]

  This makes you more at risk for heart disease and early heart attacks. Many people with this condition also have higher rates of glucose intolerance and obesity. [healthline.com]

• Chest Pain

  Severely restricted blood flow in the heart muscle leads to symptoms such as chest pain. For a healthy diet, replace unhealthy and fattening foods with healthier alternatives, such as fresh fruits and vegetables. [mountsinai.org]

  Complications may include: Early atherosclerotic heart disease Heart attack Stroke Seek medical care right away if you have chest pain or other warning signs of a heart attack. [medlineplus.gov]

  When symptoms appear, they may include: Chest pain (angina) or other signs of coronary artery disease may be present at a young age. Cramping of one or both calves when walking. Sores on the toes that do not heal. [stlukes-stl.com]

• Pruritus

  Common side effects include dyspepsia, abdominal pain, cholelithiasis, rash, and pruritus. Fibrates may potentiate the effects of warfarin (N Engl J Med 1999;341:498). [unboundmedicine.com]

  Flushing, pruritus, abdominal pain, nausea, vomiting, elevated liver enzyme levels, glucose intolerance, rare reversible acanthosis nigricans To decrease flushing, take in p.m.; take aspirin 30 minutes before, avoid concomitant ingestion of alcohol or [aafp.org]

• Myalgia

  GI, myalgias, arthralgias, headaches, dizziness, elevated liver enzymes Report malaise, fever or any muscle tenderness or weakness. Avoid consumption of alcohol and grapefruit juice while taking this medicine. [aafp.org]

  Myalgias are the most common cause of statin discontinuation and are often dose dependent. [unboundmedicine.com]

  Simvastatin (20-80 mg/day) Atorvastatin (10-80 mg/day) Pravastatin (20-80 mg/day) Fluvastatin (20-80 mg/day) Lovastatin (20-80 mg/day) Rosuvastatin (10-40 mg/day SE:Statins are generally well tolerated and serious side- effects are rare (well below 2%). 1-Myalgia [slideshare.net]

• Irritability

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

  […] interfere with bio-availability of other drugs. 4-Nicotinic acid (vitamin B3) In pharmacological doses 1-reduces peripheral fatty acid release 2- decrease cholesterol and TG 3-HDL-C increases 33. side-effects 1-Flushing occurs universally 2- gastric irritation [slideshare.net]

• Insomnia

  GI, myalgias, back pain, headaches, dizziness Abdominal pain, insomnia, elevated liver enzymes Report malaise, fever or any muscle tenderness or weakness. Avoid consumption of alcohol and grapefruit juice while taking this medicine. [aafp.org]

The biochemical profile has several specific traits: reduced HDL level (<40 mg/dL), high LDL level (> 160 mg/dL) and/or high triglyceride (TG) level (> 200 mg/dL). High LDL and TG levels (in association) are usually not found in the general population, only one of them is usually present. These parameters must be evaluated in a recurrent manner, keeping in mind that members of the same family may have different phenotypes [8]. Familial combined hyperlidemia is also characterized by increased apo B levels (> 125 mg/dL), which also constitutes a good prognostic factor [9].

Vascular echography is used to measure carotid artery intima-media thickness, which is increased in patients that already had a cardiovascular or cerebrovascular event. Other echography findings, like increased pulse wave velocity and reduced flow mediated dilation are reliable parameters that assess endothelial dysfunction and arterial stiffness, but are unable to increase event prediction [10]. Ultrasound analysis should not be limited to carotid arteries, it should also be performed on femoral arteries and the aorta. Silent myocardial ischemia should also be taken into consideration and evaluated using stress tests. Echography of the heart and the aorta should be performed every year. Computed-tomography coronary angiography is also an option in uncertain cases. Carotid intima medial thickness should also be assessed in children. They can also benefit from positron emission tomography scans in selected cases because if significant plaque is present, hypolipemic treatment may be initialized by a pediatric cardiologist.

Genetic studies reveal a locus on chromosome 1 (1q21-q23) that is linked both to familial combined hyperlidemia and type 2 diabetes [11]. Apo AV gene may also be linked to disease transmission [12], as well as the gene encoding upstream transcription factor 1 [13]. However, gene expression depends on environmental factors, making the diagnosis even more difficult [14].

• LDL Cholesterol Decreased

  Tests will show: Increased LDL cholesterol Decreased HDL cholesterol Increased triglycerides Increased apolipoprotein B100 Genetic testing is available for one type of familial combined hyperlipidemia. [medlineplus.gov]

• Triglycerides Elevated

  Fredrickson Classification of Hyperlipidemia (Open Table in a new window) Type Serum Elevation Lipoprotein Elevation I Cholesterol and triglycerides Chylomicrons IIa Cholesterol LDL IIb Cholesterol and triglycerides LDL, VLDL III Cholesterol and triglycerides [emedicine.medscape.com]

• HDL Increased

  Atorvastatin was significantly more effective in reducing total cholesterol, LDL cholesterol, apolipoprotein B, and non-high-density lipoprotein (HDL) cholesterol. Conversely, triglycerides decreased and HDL increased more during fenofibrate. [ncbi.nlm.nih.gov]

RESULTS: Before treatment, TG were similar between the -493T allele carriers and non-carriers. [ncbi.nlm.nih.gov]

Early detection and treatment of this disease may delay artery blockage. Treatment & Monitoring What are the treatments for the condition? Anyone with this condition should speak to a healthcare provider about treatment. [medicineonline.com]

To achieve this, lifestyle changes, medications such as statins, and/or treatment of associated conditions may be used The prognosis is favorable if Familial Combined Hyperlipidemia is diagnosed early and treated promptly. [dovemed.com]

Outlook (Prognosis) How well you do depends on: How early the condition is diagnosed When you start treatment How well you follow your treatment plan Without treatment, heart attack or stroke may cause early death. [mountsinai.org]

BACKGROUND: Familial combined hyperlipidemia (FCH) is the most common genetic lipid disorder with an undefined genetic etiology. Apolipoprotein A5 gene (APOA5) variants were previously shown to contribute to FCH. [ncbi.nlm.nih.gov]

(Etiology) Familial Combined Hyperlipidemia is passed down through the families. It is the most common genetic disorder causing abnormal lipid levels in blood. [dovemed.com]

See other definitions of FCHL Samples in periodicals archive: Their topics include how much evidence is enough, epidemiological aspects of lipid and lipoprotein levels in relation to cardiovascular diseases, whether raising HDL protects against atherosclerosis [acronymfinder.com]

Statistical analysis for genetic epidemiology, Version 4.0 Beta 6, 2000. Case Western Reserve University, Cleveland, 2000 22 S.A.G.E. Statistical analysis for genetic epidemiology, Version 3.1 Beta 6, 1997. [nature.com]

Epidemiology [ 1 ] The UK population has one of the highest average serum cholesterol levels in the world. Two thirds of the UK population have a serum cholesterol level greater than 5.2 mmol/L. [patient.info]

Statistical Analysis for Genetic Epidemiology, Release 2.2. 1994 Computer program package available from the Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio. This program is supported by a U.S. [diabetes.diabetesjournals.org]

To conduct focused studies of lipoprotein physiology and pathophysiology in genetically characterized patients with the objectives of understanding disease mechanisms, developing better treatments, and identifying and preventing early vascular disease [clinicaltrials.gov]

To study the pathophysiological basis and genetics of FCHL, we previously reported recruitment of 18 large families. [nyu.pure.elsevier.com]

This finding implies a role of adipose tissue metabolism in the pathophysiology of FCH. [ncbi.nlm.nih.gov]

Abstract Familial combined hyperlipidemia (FCHL) and familial hypertriglyceridemia (FHTG) are two common genetic forms of hyperlipidemia that differ in their clinical consequences and pathophysiology but are as yet poorly understood. [link.springer.com]

Pathophysiology of hypertriglyceridemia. Biochim Biophys Acta. 2012 May. 1821(5):826-32. [Medline]. [emedicine.medscape.com]

Prevention & Expectations What can be done to prevent the condition? An inherited condition cannot be prevented once a person is born. Genetic counseling may be helpful to couples with a family history of the disease. [medicineonline.com]

Author affiliations Royal Victoria Hospital, McGill Unit for the Prevention of Cardiovascular Disease, McGill University, Montréal, Québec, Canada Gotto Jr. [karger.com]

This novel mutation, which prevents the synthesis of Apo A-I, was also found in four family members, including three siblings and the daughter of the proband. [ncbi.nlm.nih.gov]

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2. van der Kallen CJ, Voors-Pette C, de Bruin TW. Abdominal obesity and expression of familial combined hyperlipidemia. Obes Res. 2004;12:2054–2061.
3. van der Vleuten GM, Veerkamp MJ, van Tits LJ, et al. Elevated leptin levels in subjects with familial combined hyperlipidemia are associated with the increased risk for CVD. Atherosclerosis. 2005;183:355–360.
4. Veerkamp MJ, de Graaf J, Stalenhoef AF. Role of insulin resistance in familial combined hyperlipidemia. Arterioscler Thromb Vasc Biol. 2005;25:1026–1031.
5. Sveger T, Nordborg K. Apolipoprotein B as a marker of familial hyperlipoproteinemia. J Atheroscler Thromb. 2004;11:286–292.
6. Mancuso G, La Regina G, Bagnoli M, et al. “Normolipemic” tendinous and tuberous xanthomatosis. Dermatology. 1996;193:27–32.
7. Ascaso JF, Merchante A, Lorente RI, et al. A study of insulin resistance, using the minimal model, in non-diabetic Familial combined hyperlipidemic patients. Metabolism. 1998;47:508-513.
8. Ylitalo K, Syvanne M, Salonen R, et al. Carotid artery intima-media thickness in Finnish families with familial combined hyperlipidemia. Atherosclerosis. 2002;162:171–178.
9. de Graaf J, van der Vleuten G, Stalenhoef AF. Diagnostic criteria in relation to the pathogenesis of familial combined hyperlipidemia. Semin Vasc Med. 2004;4:229–240.
10. Ter Avest E, Holewijn S, van Tits LJ, et al. Endothelial function in familial combined hyperlipidaemia. Eur J Clin Invest. 2007;37:381–389.
11. Allayee H, Krass KL, Pajukanta P, et al. Locus for elevated apolipoprotein B levels on Chromosome 1p31 in families with familial combined hyperlipidemia. Circ Res. 2002;90:926–931.
12. Eichenbaum-Voline S, Olivier M, Jones EL, et al. Linkage and association between distinct variants of the APOA1/C3/A4/A5 gene cluster and familial combined hyperlipidemia. Arterioscler Thromb Vasc Biol. 2004;24:167–174.
13. Pajukanta P, Lilja HE, Singheimer JS, et al. Familial Combined hyperlipidemia is associated with upstream transcription factor 1 (USF 1) Nat Gen. 2004;36:371–376.
14. Stalenhoef AF. Interaction between genes and environment in inherited lipid disorders determines clinical presentation. Cardiovasc Drugs Ther. 2002;16:271–272.