Coronary heart disease and stroke are the most dangerous diseases to the life and health of our residents, and these are basically vascular diseases in nature. Active screening and intervention of dyslipidemia is of great significance to the maintenance of vascular health. 1.What is blood lipid? Lipids is a general term for cholesterol, triglycerides (TG) and lipids in the blood. In the laboratory tests provided by most hospitals, lipid tests mainly include two groups of parameters: cholesterol and TG. Total cholesterol (TC) is subdivided into high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Among them, LDL-C has the closest relationship with atherosclerotic cardiovascular disease (ASCVD) such as coronary heart disease and stroke, and it is recommended that medical institutions must include this indicator in their blood lipid tests. 2.What are the dangers of dyslipidemia? Both cholesterol and TG are components that exist in a healthy person’s body and are essential for maintaining normal life activities. However, if TC, LDL-C, TG is too high or HDL-C is too low, it can have a negative impact on human health and is called dyslipidemia. Of the above parameters, the most important to emphasize is LDL-C, the higher the index, the greater the risk of ASCVD. In addition, a severe increase in TG (≥5.6 mmol/L) increases the risk of acute pancreatitis, which is also a very serious disease. 3. Why is LDL-C the main target of intervention? Different types of lipoproteins play different roles in atherosclerotic plaque formation. One of them, LDL, is responsible for transporting cholesterol from the liver into the plaque, while HDL plays the opposite role and is responsible for transporting cholesterol out of the plaque (reverse cholesterol transport). Therefore, LDL-C is also called “bad cholesterol” and HDL-C is called “good cholesterol.” The higher the LDL-C, the easier it is to form plaques; the lower the HDL-C, the higher the risk of plaques. It is for this reason that LDL-C is the most important of the lipid parameters mentioned earlier. Reducing LDL-C levels is one of the most important strategies for combating ASCVD, and this indicator is seen as the main target for intervention in dyslipidemia. 4. Who needs to have their blood lipids checked? The following people need to check their blood lipids annually: (1) patients who have developed coronary atherosclerotic heart disease, cerebrovascular disease or peripheral atherosclerotic disease; (2) patients with high blood pressure, diabetes mellitus, obesity, smokers; (3) people with a family history of coronary atherosclerotic heart disease, stroke, or other atherosclerotic diseases, especially those who have an early morbidity or mortality in the immediate family, and those with hyperlipidemia in the family; (4) people with a family history of coronary atherosclerosis, stroke or other atherosclerotic diseases. (4) People with yellow tumor or yellow warts; (5) Men over 45 years old and postmenopausal women; (6) Dizziness, headache, insomnia, chest tightness and shortness of breath, memory loss, poor concentration, forgetfulness, obesity, heaviness of limbs or numbness of limbs and so on; (7) Other healthy adults are better to be tested once a year, and at least once every 3-5 years to check the blood lipids. 5.How to treat the normal value in the blood lipid test? Most of the hospital labs will indicate the reference value range of each lipid index, in fact, the so-called reference value does not have much clinical significance. Some people think that as long as all the lipid parameters are within the reference value range, they are healthy, which is a wrong concept. The so-called normal values are relative. As mentioned earlier, cholesterol is the raw material for the formation of arterial plaque. The higher the cholesterol (especially LDL-C), the more likely plaque formation will occur. However, the relatively safe cholesterol level varies from person to person. If someone is younger, does not smoke, is not obese, does not have parents with cardiovascular disease, does not have high blood pressure and diabetes, their LDL-C can be as long as it does not exceed 4.1 mmol/L; if the patient has developed coronary heart disease and is comorbid with diabetes, their LDL-C should be treated if it exceeds 1.8 mmol/L. Therefore, it should not be assumed that no treatment is needed if all the indicators on the lipid panel are within the reference range. Because there are many factors to consider, patients should not decide on their own whether to use medication or not, and should follow the doctor’s advice. 6.How to carry out lifestyle intervention? Patients should be routinely stratified by cardiovascular risk, assess the risk of ASCVD and be guided by lifestyle therapy. If the cholesterol level of the patient cannot reach the target value after lifestyle intervention, or the patient cannot adhere to effective lifestyle intervention, cholesterol-lowering drug therapy should be initiated. Lifestyle treatment should include the following: (1) Control of dietary cholesterol intake. Dietary cholesterol intake <200 mg/d, saturated fatty acid intake no more than 10% of total calories, trans fatty acid no more than 1% of total calories. Increase the intake of vegetables, fruits, crude fiber foods, and fish rich in n-3 fatty acids. Salt intake should be controlled at <6 g/d. Limit alcohol consumption (alcohol intake <25 g/d for men and <15 g/d for women); (2) Increase physical exercise. Adhere to 30-60 min of moderate-intensity aerobic exercise daily for at least 5 d per week, and continue to increase the weekly exercise time for those who need to lose weight; (3) Maintain ideal body weight. Maintain body mass index at <25 kg/m2 by controlling total calorie intake in the diet and increasing physical activity; the initial goal of weight loss for overweight/obese patients is a 5% to 10% reduction in body weight from baseline; (4) Control other risk factors. For patients who smoke, smoking cessation can help reduce cardiovascular risk levels. Some patients with mild or low-risk dyslipidemia may be able to keep their lipid parameters in the desired range with effective lifestyle interventions. Even in patients who must be treated with medications, active and effective therapeutic lifestyle modification can help to reduce the dose of medications. At the same time, intensive lifestyle interventions not only help to lower cholesterol levels, but also have beneficial effects on blood pressure, blood glucose, and overall cardiovascular health, effectively reducing the risk of developing ASCVD. Lifestyle improvement should be the basic strategy for dyslipidemia management and ASCVD prevention. 7. Why is statin the most important cholesterol-lowering drug? At present, the commonly used lipid-lowering drugs in our clinic mainly include statins, fibrates, niacin and cholesterol absorption inhibitors. Lovastatin as the main active ingredient in China's research and development of blood lipids Kang's clinical application is also very extensive. Among the above drugs, statins have the most sufficient evidence from randomized clinical studies, and they are the lipid-regulating drugs that can significantly improve the prognosis of patients. Biotics and niacin have been widely used in clinical practice. These two classes of drugs not only significantly reduce TG and elevate HDL-C levels, but also moderately reduce LDL-C levels. However, several randomized clinical studies concluded in recent years have found that fibrates and nicotinic acid failed to significantly reduce major cardiovascular endpoints and all-cause mortality in subjects, although they may have a beneficial effect on lipid profiles. Therefore, these two classes of drugs are not recommended as the first choice for dyslipidemia pharmacologic interventions unless the patient's TG is severely elevated or the patient cannot tolerate statin therapy. When TG remains substandard (>2.3 mmol/L) after intensive lifestyle intervention and adequate statin therapy, the addition of fenofibrate or niacin extended-release to statin therapy may be considered. 8.What should be done when patients cannot tolerate statin therapy? Clinically, a small number of patients may not be able to tolerate the regular dose of statin therapy, then the following measures can be considered: (1) replacement of another statin; (2) reduce the dose of statin or change to every other day; (3) switch to other types of alternative drugs (eg, ezetimibe); (4) alone or in combination with the use of beta or niacin extended-release agents; (5) to further enhance the lifestyle treatment. If patients need to use but cannot tolerate high-dose statin therapy, small and medium-dose statin combined with ezetimibe can be used. 9. Does dyslipidemia require long-term treatment? Adherence to non-pharmacological treatment is an important measure to correct dyslipidemia. Dietary control and active exercise should be continued even after medication is started, and lifestyle intervention should not be relaxed because of medication. Most patients, especially those who have developed ASCVD and/or diabetes mellitus, require long-term medication. The risk of ASCVD, such as myocardial infarction or stroke, will be significantly increased if cholesterol is lowered below the target value after a period of treatment and the dose of the medication is reduced. 10.Do I need to recheck my lipid level frequently during the treatment? Lipid levels should be rechecked 3 to 6 months after lifestyle intervention. If LDL-C and other lipid parameters reach the standard, the treatment should be continued, but it is still necessary to recheck every 6 months to 1 year. If the LDL-C continues to be below the target value, a review once a year is sufficient. Lipids and liver function and CK should be reviewed 4 to 8 weeks after the start of drug therapy, and if there are no special circumstances, the review should be gradually changed to every 6 to 12 months. If the LDL-C still does not reach the target value after 3~6 months of starting treatment, adjust the dose or drug type, or combine drug therapy, and review after another 4~8 weeks. After reaching the target value, it was extended to 1 review every 6~12 months.