Tuesday, October 29, 2013

Familial Hyperlipoproteinemia

My daughter was very kind to share some of her recent lab reports with me. They confirm that she shares the same lipid dysfunction that my brother and I have. I used to know the exact name from my time at Kaiser, but needed to review the options at Wiki. I am virtually certain that we have

Hyperlipoproteinemia IIb.

[Note: I have reported elsewhere in this Blog that is is "IIIb" whereas it appears to be IIb. Type III has no "b".]

The link is the Wikipedia article is here. The symptoms as reflected in my lab results are 1) elevated overall cholesterol (but not necessarily by very much 200-240 without medication, 2) low HDL (under 40 which is the low threshold for normal), 3) elevated triglycerides (over 125 according to the current threshold), and 4) elevated LDL's (over 100 where 75 is ideal). 

The type IIb description is spot on except for the how HDL's, though this could be a consequence of the other conditions described. Only 1% of the population has this.

Having low HDL's is a bummer. They are the "good" lipids that can dissolve/control the bad lipids (LDL's in particular). I have a 91 year-old biking companion whose HDL's are also in the 90's. At least one sister has HDL's in the 50's - so she doesn't share this syndrome. Omega-3 supplements can help here. Also possibly Niacin, though there is apparently some discussion currently on the efficacy of niacin.

Having high LDL's is a bummer. LDL-level is probably the best predictor of heart incidents, particularly strokes. After exercise and diet, statins are the best defense here. Small amounts of Crestor have reduced my LDL's from over 125 to the mid-70's. This is encouraging, but I am still a candidate for heart attack, stroke and mini-strokes. Even with treatment the "official" likelihood of a cardiac event in the next 10 (72-82) years is about 1/3. This gets one's attention. A recent stroke (thankfully not debilitating) within the family gets my attention. How best does each family member deal with this kind of lipid dysfunction?
  • No question. Start with diet and exercise. The loss of even 10 pounds can help  -- lower overall cholesterol for one. 
  • Omega-3 for sure. I take 4 grams of prescription Omega-3/day. That's Lovaza.
  • High fiber supplements can help. ("sequestrants" fibrous materials that can bind up lipids in the bowel). Psyllium on occasion. Lot's of fruits and veggies, less dairy, salty snack foods, etc.
  • But  low doses of statins are a necessary part of the response to this lipid problem. Even 2.5 mg/day has had a big effect on my LDL's, getting me to as low as 77 (but currently 89).
  • Trilipix has been a big help as well. It has brought my triglycerides down to below normal and has helped with respect to overall cholesterol (and maybe LDL/s) as well. It's not a straight-out statin (rather a fibrate I think) -- I'll check it out, but for now I need it.
That's about it. I take Ubiquinol (COQ10), the new form ("ol" rather on "one") which is more readily dissolved and effective. The statins remove Q10 from the system so that it needs to be replaced. I wish more doctors said this to their patients.

Finally, I take Zetia which binds with lipids in the gut (and has been shown to have virtually no side effects). 

And a baby aspirin (very important). :)

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