Combined hyperlipidemia (or -aemia) is a commonly occurring form of hypercholesterolemia (elevated cholesterol levels) characterised by increased LDL and triglyceride concentrations, often accompanied by decreased HDL. : 534  On lipoprotein electrophoresis (a test now rarely performed) it shows as a  hyperlipoproteinemia type IIB. It is the most commonly inherited lipid disorder, occurring in around one in 200 persons. In fact, almost one in five individuals who develop coronary heart disease before the age of 60 have this disorder. The elevated triglyceride levels (>5 mmol/L) are generally due to an increase in very low density lipoprotein (VLDL), a class of lipoproteins prone to cause atherosclerosis. Cause
Hereditary factors are the most common cause. A diet high in saturated fat and cholesterol increases blood cholesterol and triglyceride levels. Other disorders, such as diabetes mellitus, kidney disease, and hypothyroidism, may promote hypertriglyceridemia. Certain drugs, such as estrogen, corticosteroids, retinoids, protease inhibitors, thiazide diuretics, and beta-blockers, may cause hypertriglyceridemia. Obesity increases the risk of hyperlipidemia. Chronic, excessive alcohol use increases the risk of hypertriglyceridemia. Smoking and not exercising may lead to hyperlipidemia. Steroid uses, alcoholism, hypothyroidism, oral contraceptives, chronic kidney failure, hypopituitarism, and nephritic syndrome are other contributors to hyperlipidemia. Diagnosis
Types
The two forms of this lipid disorder are:

Familial combined hyperlipidemia (FCH) is the familial occurrence of this disorder, probably caused by decreased LDL receptor and increased ApoB. Acquired combined hyperlipidemia is extremely common in patients who have other diseases from the metabolic syndrome ("syndrome X", incorporating diabetes mellitus type II, hypertension, central obesity and CH).
Gustatory hyperhidrosis is excessive sweating classified under focal hyperhidrosis, that is, it is restricted to certain regions of the body. Affected people regularly experience this on the forehead (scalp), upper lip, perioral region, or sternum a few moments after eating spicy foods, tomato sauce, chocolate, coffee, tea, or hot soups.A common cause is trauma or damage to the nerve that passes through the parotid gland, which can be due to surgery of the parotid gland (parotidectomy). This type of sweating is known as Freys syndrome. Gustatory hyperhidrosis has been observed in diabetics with autonomic neuropathy, and a variant of this disorder has been reported following surgical sympathectomy.Around 10% of affected people require treatment. One of the more effective treatments is oral or topically applied glycopyrrolate. == References ==