In adults, what is the clinical definition, diagnostic criteria, and

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Clinical definition Mixed hyperlipidaemia (mixed dyslipidaemia) is a lipid-pattern diagnosis in which both cholesterol-containing atherogenic lipoproteins and triglycerides are raised; in practice, identify this from a full lipid profile showing elevated non-HDL cholesterol together with elevated triglycerides, rather than from a single universal diagnostic threshold. 5 NICE does not provide a standalone numerical case definition or formal diagnostic scoring system for mixed hyperlipidaemia. 2 , 5 Diagnostic approach Obtain a full lipid profile, which measures total cholesterol, HDL cholesterol and triglycerides, with calculated non-HDL and LDL cholesterol; fasting is not routinely required. 5 Assess the lipid pattern, clinical findings and family history, and do not rely on strict lipid cut-offs alone when considering a familial lipid disorder. 2 , 5 Exclude or treat secondary causes, including excess alcohol intake, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome. 5 Record cardiovascular risk factors and baseline tests before statin treatment: smoking status, alcohol intake, blood pressure, BMI, lipid profile, liver transaminases, renal function and diabetes status; measure CK for persistent unexplained generalised muscle symptoms and TSH when thyroid disease is suspected. 1 Consider familial hypercholesterolaemia when total cholesterol exceeds 7.5 mmol/L or there is personal or first-degree family history of premature CHD before age 60 years; take two LDL-C measurements, exclude secondary causes, and use Simon Broome or DLCN criteria in primary care. 3 , 4 Arrange specialist assessment for total cholesterol above 9.0 mmol/L or non-HDL cholesterol above 7.5 mmol/L. 2 , 5 For triglycerides 10–20 mmol/L, repeat a fasting triglyceride measurement after 5 days but within 2 weeks, review secondary causes and seek specialist advice if the result remains above 10 mmol/L. 2 , 5 Refer urgently for specialist review if triglycerides exceed 20 mmol/L and this is not attributable to excess alcohol intake or poor glycaemic control. 2 , 5 With triglycerides 4.5–9.9 mmol/L, recognise that CVD risk tools may underestimate risk, optimise other risk factors and seek specialist advice if non-HDL cholesterol exceeds 7.5 mmol/L. 2 Management Address lifestyle and reversible contributors, including weight management, physical activity, alcohol reduction where relevant and smoking cessation. 1 , 5 Manage lipid lowering according to overall CVD prevention indication rather than a diagnosis label alone. 1 For primary prevention, offer atorvastatin 20 mg daily if lifestyle measures are ineffective or inappropriate in people at sufficient CVD risk, including QRISK3 10% or more, type 1 diabetes, chronic kidney disease, familial hypercholesterolaemia, or age 85 years and over; aim for a greater than 40% reduction in non-HDL cholesterol. 1 For established CVD, offer atorvastatin 80 mg daily regardless of cholesterol level, alongside lifestyle advice, aiming for LDL-C of 2.0 mmol/L or less or non-HDL cholesterol of 2.6 mmol/L or less. 1 If a statin is contraindicated or not tolerated, consider ezetimibe. 1 Do not routinely offer fibrates, niacin, bile-acid sequestrants, omega-3 fatty-acid compounds, or statin combinations with these agents solely to prevent CVD; icosapent ethyl is the stated exception where used in line with its NICE technology appraisal. 5 Fibrate therapy may be considered within its licensed indication for mixed hyperlipidaemia when a statin is contraindicated or not tolerated, and fenofibrate is also licensed as add-on therapy in high-CVD-risk patients whose triglycerides and HDL cholesterol remain inadequately controlled on a statin. 8 , 9

<p>In adults, what is the clinical definition, diagnostic criteria, and

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<p>In adults, what is the clinical definition, diagnostic criteria, and

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