Q: I am 36 years old and on treatment for elevated triglyceride levels and high cholesterol levels for the past one year. I am taking 20 mg Atorvastatin but this is not helping. I read recently that a combination therapy of 200 mg Fenofibrate and 20 mg Atorvastatin leads to good results. Can you please advise if it is feasible to try the above combination and with what safeguards?

A:You could be having Metabolic Syndrome, which consists of high blood pressure, high TG, low good cholesterol (HDL<40), overweight/protruding tummy your Body Mass Index (BMI), which is weight divided by height in meters square, is 34. Normal should be less than 25), and marginally increased fasting and post-prandial blood sugars. The treatment, especially because you are young, consists mainly of changes in your life style. You should reduce your calories by consuming less fats, rice and quick foods; taking more natural products like vegetables, vegetable juices, sprouted legumes & fruits. You should change polished rice to whole grain cereals (unpolished rice/ whole wheat atta). You should exercise daily to loose atleast 6 kgs over the next 6 months. You may discuss with your doctor about replacing Atenelol with any other commonly used BP drug like Amlodipine 5 mg, because Atenelol + the H in Losar H may make the metabolic syndrome worse. Fenofibrate lowers triglycerides more than Atorvastatin. If LDL is high (>130) you may need to add 10 mg Atorvastatin to Fenofibrate. The combination has slightly more side effects, which can be easily monitored with 6 monthly liver function tests like AST and CK (muscle enzyme test) & symptoms like muscle pain. Another option you may try if your triglycerides are not too high (>500) and LDL is high is a combination of Atorvastatin 10 mg + ezetemibe 10 mg. Ezetemibe does not get absorbed and acts in the gut only. Triglycerides are much more susceptible to life style changes than LDL; so you may check on the necessity to use specific drugs to lower triglycerides after repeat lipid profile checking, after you loose weight