Case presentation

A 55 year old obese female patient presented to the clinic for routine health check up. The patient had a history of deranged lipid levels and was already given moderate dose of statin. Previous lipid profile of the patient was suggestive of elevated triglyceride levels.

General physical examination:

• Height: 5’2”
• Weight: 86 kg
• Waist circumference: 40”
• Body mass index (BMI): 34.7
• Blood pressure: 158/110 mmHg
• Cardiac examination: S1, S2- normal, No pathological murmur noted

The patient was asked to get lipid profile, blood glucose level, and glycated hemoglobin (HbA1c) level checked and gives a follow up.

Laboratory examination:

• Lipid profile:
  • Total cholesterol: 200 mg/dl
  • Low-density lipoprotein-C (LDL-C): 110 mg/dl
  • High-density lipoprotein-C (HDL-C): 30 mg/dl
  • Triglycerides (TG): 300 mg/dl
• Fasting blood sugar (FBS): 100 mg/dl
• HbA1c: 5.4%

Results of investigations revealed highly elevated levels of TG, marginally raised levels of TC, and LDL with comparatively lower level of HDL-C. Persistent elevated triglycerides associated with abdominal obesity, and hypertension contemplates a high end risk factor for cardiovascular diseases in coming future.

Intervention

The patient was asked to do weight reduction through dietary and lifestyle modifications. She was prescribed statin + fibrate combination along with antihypertensive drugs. Investigations after 2 months follow up revealed considerable improvements in blood pressure levels and lipid parameters of the patient.

Discussion

Hypertriglyceridemia is a frequently occurring lipid abnormality in persons with obesity and hypertension and is a well demarcated risk factor for cardiovascular diseases. Treatment modalities for hypertriglyceridemia are based on National Cholesterol Education Program Adult Treatment Panel (NCEP) guidelines. According to NCEP guidelines lifestyle modification and dietary supplements is an important therapeutic strategy. Statins often in combination with fibrates are the first line agents for marked hypertriglyceridemia.

Clinical evidence

A study was conducted to evaluate the efficacy and safety of combinations of rosuvastatin (R) (5mg, 10mg, and 20 mg for further 8 weeks) + fenofibric acid (FA) 135mg compared with simvastatin 40mg in patients with high levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). The results of the study revealed that combination therapy with R+FA produced greater reductions in LDL-C and TGs level compared to simvastatin alone.

Hence, it was concluded that combination therapy of rosuvastatin fibrate is more efficacious and provide better results compared to simvastatin alone.

References

• Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol. 1998 Feb 26;81(4A):7B-12B.
• Berglund L, John D. Brunzell, Anne C. Goldberg, Goldberg I J, Sacks F, Murad MH, Anton F. H. Stalenhoef. Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012 Sep; 97(9): 2969–2989.
• Roth EM, McKenney JM, Kelly MT, Setze CM, Carlson DM, Gold A, Stolzenbach JC, Williams LA, Jones PH. Efficacy and safety of rosuvastatin andfenofibricacidcombinationtherapyversussimvastatinmonotherapy in patients with hypercholesterolemia and hypertriglyceridemia: a randomized, double-blind study. Am J Cardiovasc Drugs. 2010;10(3): 175-86.