Over the past 30 years, blood lipid levels in the Chinese population have gradually increased, and the prevalence of dyslipidemia has increased significantly. Patients with dyslipidemia often need to take lipid-lowering drugs to control their blood lipids in order to prevent the occurrence of cardiovascular diseases such as atherosclerosis. In the clinic, there will be a part of the patient’s blood lipid level in the normal range, but the doctor will also prescribe lipid-lowering drugs, these patients will often feel puzzled: my blood lipid is obviously not high, why do I have to take lipid-lowering drugs? Such a question will reduce the patient’s adherence to the medication, which in turn will affect the therapeutic effect. In this article, we will introduce the concept of blood lipids, normal range, target value and which patients need lipid-lowering treatment, and hope you will gain some benefits. I. What is blood lipid? Lipids is a general term for cholesterol, triglycerides and lipids (e.g. phospholipids) in the blood serum, and the lipid components that are closely related to the clinic are mainly cholesterol and triglycerides. Lipids are insoluble in water and must be combined with a special protein, apolipoprotein, to form lipoproteins before they can be dissolved in the blood and transported to tissues for metabolism. LDL and HDL, which we often see on lab tests, are lipoproteins, and they are both vehicles for transporting cholesterol. The basic items of clinical lipid testing are total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), the so-called four lipids. Second, the normal range of blood lipids The main hazard of dyslipidemia is to increase the risk of atherosclerotic cardiovascular disease (ASCVD, such as coronary heart disease and cerebral infarction). 3.4mmol/L, HDL cholesterol has no fixed reference range, but should not be lower than 1.0mmol/L. It should be emphasized that the above normal range is set for large-scale healthy populations, but the risk of atherosclerotic cardiovascular disease varies among different populations (e.g., smokers are greater than non-smokers), and patients with very high risk of cardiovascular disease need to be treated with atherosclerosis. Patients with a high risk of CVD will need to lower their lipids even more in order to prevent the disease. Therefore, it is not the case that a patient can rest easy if his or her blood lipids are in the normal range, but rather that a specialist needs to set specific lipid targets by stratifying the individual’s cardiovascular risk. Target value of blood lipids LDL-C is the culprit of atherosclerosis and has the closest relationship with cardiovascular diseases, therefore, the level of LDL-C is mainly used as the target of lipid lowering in clinical practice. For low and medium-risk patients, it is enough to control LDL-C in the normal range; for high-risk patients, it is necessary to control it below 2.6mmol/L; for very high-risk patients, we are surprised to find that the LDL-C of this group needs to be controlled below 1.8mmol/L to be considered as meeting the standard, which can be lower than the lower limit of the normal reference value on the laboratory sheet! Even if the blood lipids of these patients are in the normal range, they still need to take lipid-lowering drugs in order to lower them even more. See here, we can breathe a sigh of relief: ate so many years of lipid-lowering drugs are not for nothing! V. Risk assessment of atherosclerotic cardiovascular disease Since high-risk patients need to be more stringent lipid-lowering, the question arises: which patients belong to the high-risk and very high-risk? Let’s take a look at some simple ones first. Those who meet any of the following conditions can be directly classified as high-risk or very high-risk: very high-risk-ASCVD patients; high-risk-(1) LDL-C ≥ 4.9mmol/L or TC ≥ 7.2mmol/L (2) diabetic patients with 1.8mmol/L ≤ LDL-C< 4.9mmol/L (or) 3.1mmol/L ≤ TC< 7.2 mmol/L and age ≥40 years. In other words, if one has ASCVD, such as having coronary artery disease or even myocardial infarction, or suffering from cerebral infarction, then one is in a very high-risk group, and needs to keep blood lipids very low in order to do so. If you do not meet the above criteria, you need to determine the degree of risk through the combination of hypertension, cholesterol levels, smoking, body mass index and other risk factors for a comprehensive assessment, the details are very complex, and will not be repeated here, leave it to your doctor to help you determine. How to lower lipids Dietary treatment and lifestyle improvement are the basic measures for treating dyslipidemia, which is obviously affected by diet and lifestyle. Regardless of whether medication is used for lipid-lowering treatment, dietary control and lifestyle improvement must be adhered to, including adhering to a healthy diet, regular exercise, quitting smoking and limiting alcohol consumption, and maintaining an ideal body weight. If medication is needed, statins (e.g., Rosuvastatin) are preferred as inhibitors of cholesterol synthase, which can significantly lower TC and LDL-C, and also have a certain effect on triglycerides. In addition, cholesterol-lowering drugs include ezetimibe, which can be used in combination when statins fail to lower cholesterol to target values. If triglycerides are predominantly elevated, fibrates can be used. Lastly, I would like to emphasize that lipid-lowering treatment should always be carried out under the guidance of a doctor! Cherish your life, lower your lipids, and stay away from cardiovascular disease.