I. What are the clinical manifestations of dyslipidemia?
Last time we talked about the clinical manifestations of dyslipidemia, there are not many, or they are not typical, but there are still some clinical symptoms and signs when you look closely. However, since the incidence of yellow tumors is not too high, and the occurrence and development of atherosclerosis takes a long time (dozens or even decades), people have the impression that there are no obvious signs and symptoms of dyslipidemia. Ma Ming, Department of Traditional Chinese Medicine and Geriatrics, China-Japan Friendship Hospital
1. Yellow tumor: It is a kind of yellow, orange or brownish-red limited skin elevation, which can be in the shape of nodules, plaques or papules, with a soft texture. The most common is flat yellow tumor, which is mostly found in the eyelid area, so it is also called lid yellow tumor, which is a flat orange tumor around the eyelid that is slightly higher than the skin surface, with clear borders and soft texture, and can also be found on the face, neck, trunk and limbs. In addition, there are also tendon yellow tumors, palmar yellow tumors, nodular yellow tumors and rash yellow tumors.
2, lipid corneal arch: appear in the edge of the cornea gray-white cloudy ring, especially in familial hypercholesterolemia, but the specificity is not strong. It can also be seen in some elderly people, so it is also known as senile ring.
3. Retinal lipemia: It is due to severe celiac disease, where large particles of lipoproteins are deposited on the vessel walls, causing light scattering and characteristic changes in the retinal vessels. It is seen in severe hypertriglyceridemia.
4. Acute pancreatitis: due to severe hypertriglyceridemia (which may be induced when triglycerides exceed 5.7 mmol/L or higher).
Second, are there any types of dyslipidemia?
From a professional point of view, there are several ways to classify dyslipidemia. As a general knowledge, we will only introduce two types of dyslipidemia that are more commonly used clinically and easy to understand and grasp.
1.Classification according to etiology: primary and secondary dyslipidemia.
Primary dyslipidemia: It is caused by congenital genetic defects and/or acquired dietary habits, lifestyle and environmental factors.
Secondary dyslipidemia: It is caused by systemic diseases, such as diabetes, nephrotic syndrome, hypothyroidism, kidney failure, liver disease, systemic lupus erythematosus, myeloma, polycystic ovary syndrome, etc. Certain drugs such as diuretics, beta-blockers, glucocorticoids, etc.
2. Clinical simple typing method: According to the abnormalities of lipid indicators, there are four types of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia and low-density lipoproteinemia.
What should I pay attention to when having a lipid test? Who should go for lipid test?
Before the lipid test, it should be noted that the patient must be fasting for at least 12 hours, and the last meal before the blood test should be free from alcohol and high-fat diet. If the results are abnormal, the test should be repeated in two weeks.
The key targets of lipid screening are: ① those with coronary heart disease, cerebrovascular disease or peripheral vascular disease; ② those with hypertension, diabetes, obesity and smoking; ③ those with a family history of coronary heart disease or atherosclerosis, especially those with early onset coronary heart disease or other atherosclerotic diseases in the immediate family; ④ those with yellow tumors; ⑤ those with familial hyperlipidemia.
In order to improve the detection rate of dyslipidemia, it is recommended that: ① adults over 20 years of age should be measured at least once every 5 years; ② men over 40 years of age and postmenopausal women should be measured once a year; ③ ischemic cardiovascular disease and high-risk groups should have their lipids measured every 3-6 months.
What are the treatment principles and goals of dyslipidemia?
The treatment of dyslipidemia should grasp the following principles and goals.
1.The treatment measures and target level of dyslipidemia should be decided according to the risk stratification (the presence or absence of ischemic cardiovascular disease, the number of various risk factors and the degree of dyslipidemia).
2.Dietary therapy and improvement of lifestyle are the primary measures and basic means to treat this disease, and should be carried out throughout the treatment.
3, the primary goal of lipid regulation therapy is to reduce LDL-C, followed by raising HDL-C, only when TG ≥ 5.65mmol/L (500mg/dl) in order to prevent the occurrence of acute pancreatitis and lower TG first.
4. Pay attention to the adverse effects of drugs and monitor them regularly when using drug therapy.