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Familial dysbetalipoproteinemia

Familial dysbetalipoproteinemia is a disorder passed down through families in which there are high amounts of cholesterol and triglycerides in the blood.

Alternative Names

Type III hyperlipoproteinemia; Deficient or defective apolipoprotein E

Causes, incidence, and risk factors

A genetic defect causes this condition. The defect results in the buildup of large lipoprotein particles that contain both cholesterol and triglycerides, a type of fat. The disease is linked to defects in the gene for apolipoprotein E in many cases.

Hypothyroidism , obesity , or diabetes can make the condition worse. Risk factors for familial dysbetalipoproteinemia include a family history of the disorder or coronary artery disease.

Symptoms

Symptoms may not be seen until age 20 or older.

Yellow deposits of fatty material in the skin called xanthomas may appear on the eyelids, palms of the hands, soles of the feet, or on the tendons of the knees and elbows.

Atherosclerosis develops at an early age. There may be early chest pain (angina) or decreased blood flow to specific parts of the body, causing transient ischemic attacks of the brain or peripheral artery disease with claudication.

Signs and tests

Tests that may be done to diagnose this condition include:

Treatment

The goal of treatment is to control underlying conditions such as obesity, hypothyroidism, and diabetes.

Reducing calories, saturated fats, and cholesterol may significantly reduce cholesterol levels.

See also: Heart disease and diet

If high cholesterol and triglyceride levels continue despite diet changes, your doctor may recommend medication to lower your triglyceride and cholesterol levels. Medicine to lower blood triglyceride and cholesterol levels include:

  • Bile acid-sequestering resins
  • Fibrates (gemfibrozil, fenofibrate)
  • Nicotinic acid
  • Statins

Expectations (prognosis)

People with this condition have an increased risk for coronary artery disease and peripheral vascular disease.

With treatment, most people show a significant reduction in lipid levels.

Complications

  • Heart attack
  • Stroke
  • Peripheral vascular disease
  • Intermittent claudication
  • Gangrene of the lower extremities

Calling your health care provider

Call your health care provider if you have been diagnosed with this disorder and:

  • New symptoms develop
  • Symptoms do not improve with treatment
  • Symptoms get worse

Prevention

Screening the family members of those with familial dysbetalipoproteinemia may lead to early detection and treatment.

Early treatment and avoiding other risk factors for vascular disease (such as smoking) are crucial to preventing early heart attacks, strokes, and blocked blood vessels.

References

Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA:Saunders Elsevier; 2011:chap 47.

Semenkovich, CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 213.

Updated: 6/4/2012

David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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