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Dear Mailbase

Any thoughts on this?

57y female hypertensive.

On atorvastatin, previous results unremarkable, e.g. 2014: chol 6.4, HDL 2.7, tg 2.0

Going back to 2002, all previous Tg less than 4

“Routine bloods” in June 2015 grossly lipaemic: Tg 73.0

Advised GP switch atorva to fenofibrate

1 week later: Tg now reasonably well controlled, thank you, 6.4 mmol/L, BUT chol now 20.6 mmol/L

All new investigations for secondary hyperlipidaemia negative – e.g. I suspected PBC but LFTs only mildly deranged (ALP 195 IU/L) except GGT= 700 IU/L, ultrasound = mild fatty liver only, immunology normal

Recheck 1 week later: chol 13.4 mmol/L Tg normal, ApoB sent to check if it is LDL and not LpX etc: 2.4g/L, i.e. consistent with a genuine marked elevation of LDL

Recheck 2 weeks later: LFTs normal, except GGT 90, lipids back to 2014 levels.

So, if gammaGT is the clue: what liver disorder will produce gross hypertriglyceridaemia responsive to fibrates but also associated with transient marked LDL increase?

Suggestions on a postcard please

Thanks

Worried of Bath

Andrew Taylor

Consultant Medical Biochemist RUH Bath

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