Q: I am 32 years old male and recently diagnosed with severe dyslipidemia. My lipid profile is: Total cholesterol is 255 mg%; HDL (direct) - 33.40 mg%; triglycerides - 893 mg%; LDL - 43 mg%; VLDL - 178.6 mg%; TC/HDL ratio - 7.63; LDL/HDL ratio - 1.29. LFT is normal except SGPT & SGOT are borderline. ECG is normal. I have been prescribed: Atorvastatin 10 mg + Fenofibrate 160 mg once daily; Omega 3 fatty acid + vitamin E twice daily. How come the LDL level is so abnormally low in such a severe case of dyslipidemia? If I take these medicines, won’t the LDL level be further lowered? What could be the clinical fallout of this low LDL level?

A:You have very high triglycerides (Tgs). At such levels LDL levels are not correctly estimated. You should check for true LDL levels after triglycerides are controlled. TG levels are very prone to change with lifestyle. Your BMI (wt in kgs divided by Ht in metrs square) is 26. It should be 23 or less. You should also severely limit your intake of processed carbohydrates (ex: polished rice)You can consume whole cereals (unpolished rice, wholewheat atta), sprouted legumes and vegetables and fruits. Exercise, weight loss, bhastrika or abdominal exercises, diet rich in fibre and low in processed carbohydrates /fat will itself lower TGs substantially. Fenofibrate 160 to 200mgs is a good drug and so is 1 to 2 gms of Omega three fatty acids/ day to reduce Tgs. You should also check fasting and 2 hours postluch sugars to exclude mild diabetes. Alcohol in any dose will increase your Triglycerides.