Article Details

Background: Severe hypertriglyceridemia (triglycerides >1,000 mg/dL) poses an immediate risk of acute pancreatitis and long-term cardiovascular complications. Management becomes substantially more challenging when compounded by concurrent familial hypercholesterolemia, Type II Diabetes Mellitus, hypertension, and obesity.
Case Presentation: We present a male patient with familial hypercholesterolemia, Type II Diabetes Mellitus, hypertension, and obesity who presented in 2021 with triglycerides of 3,575 mg/dL and total cholesterol of 500 mg/dL; prior levels exceeded 4,425 mg/dL in 2019. Combination pharmacotherapy—rosuvastatin, ezetimibe, fenofibrate, semaglutide, empagliflozin, and metformin—alongside intensive lifestyle modification produced a 97% triglyceride reduction (125 mg/dL), 87% total cholesterol reduction (110 mg/dL), and more than 65 pounds of weight loss by 2025, with an LDL-C of 43 mg/dL.
Conclusion: This case illustrates that even life-threatening, genetically complex dyslipidemia can be effectively managed through simultaneous targeting of multiple metabolic pathways. Aggressive combination pharmacotherapy, contemporary diabetes management, and pharmacologically supported lifestyle modification collectively yielded outcomes that exceeded guideline benchmarks, underscoring the value of individualized, adaptive treatment strategies.

Keywords: Triglycerides; Hypertriglyceridemia; Lipids; Weight-loss; Statins; Fibrates; Obesity; Diabetes mellitus; Hypercholesterolemia; SGLT2i; GLP-1 RA