Diagnostic stage
Hyperlipidemia itself has no specific symptoms and is usually detected during a physical examination.
For timely detection and detection of dyslipidemia, it is recommended that fasting lipids be measured at least once every 5 years in adults over 20 years of age. For ischemic cardiovascular disease and its high-risk groups, lipids should be measured every 6 to 12 months. High-risk groups include: people over 40 years old (especially men), postmenopausal women, smokers, obese, hypertensive, diabetic, atherosclerosis (including coronary heart disease), cerebrovascular disease, people with a family history of these diseases, people with familial hyperlipidemia, and people with yellow skin tumors. Yin Dong, Department of Cardiovascular Medicine, Fu Wai Hospital, Beijing
The most important indicators of lipid examination are: total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C) and triglycerides (TG). (Fasting is required before the blood test, otherwise the results are inaccurate, especially the triglyceride results have the greatest impact.)
Treatment phase: Patients should be seen in cardiology once elevated lipids are detected.
Treatment goal: To control the lipid index within the normal range. The specific control target differs according to the risk factors for atherosclerosis that the patient has. Those who already have coronary artery disease should even be below the high limit of normal values.
Treatment methods.
Non-pharmacological measures: These include dietary and other lifestyle modifications to prevent hyperlipidemia and are the basis of hyperlipidemia treatment.
(1) Dietary modifications: Applicable to both preventive and therapeutic subjects. Objective: To maintain a proper body weight, reduce excessive lipids, and take into account other unhealthy dietary structures, such as salt restriction. Modalities: control total calories; reduce fat intake, especially cholesterol and saturated fatty acids; increase the proportion of protein and carbohydrates; reduce alcohol consumption and abstain from alcoholic beverages.
(2) Other non-pharmacological measures: including exercise and smoking cessation.
(3) Non-pharmacological treatment implementation plan: After about 6-8 weeks of non-pharmacological treatment, the patient’s lipid level should be monitored and continued if it has reached the standard or has improved significantly. Otherwise, lipid lowering can be intensified by the following means. First, re-intensify the dietary therapy. Second, the use of plant sterols that can lower LDL-C (but there is no product available in China yet). The intake of dietary fiber can also be increased by choosing foods. Foods high in dietary fiber include: whole grain foods, fruits, vegetables, and various five categories.
After about 6 to 8 weeks of non-pharmacological treatment again, the patient’s lipid levels should be monitored again, and if they have reached the target or continue to improve toward the target, they should continue to be maintained and no pharmacological treatment should be initiated. If the test results indicate that it is not possible to achieve the target with non-pharmacologic therapy alone, additional pharmacologic therapy should be considered.
After satisfactory efficacy is achieved, monitor patient compliance regularly. Follow-up should be done approximately every 4 to 6 months during the 1st year of non-pharmacologic therapy and every 6 to 12 months thereafter.
2 Pharmacotherapy. (See P172 for criteria for initiation of drug therapy)
Treatment process detection
Blood lipids should be retested 4-8 weeks after the start of drug therapy, and gradually changed to every 6-12 months if the target value can be achieved. If the target value of lipids is still not reached at the recheck 3-6 months after the start of treatment, adjust the dose or drug type, or combine drug therapy and recheck after another 4-8 weeks. This is extended to every 6-12 months after the target value is reached.
Safety must be monitored during lipid-lowering drug therapy, mainly by periodic (3-6 months) testing of liver function and blood muscle enzyme profiles. If AST or ALT exceeds 3 times normal, dosing should be suspended. After discontinuation of the drug, liver function should still be rechecked weekly until it returns to normal. Patients should be asked if they have symptoms such as myalgia, myalgia, muscle weakness, malaise and fever during the course of dosing. Blood CK elevation more than 5 times normal should be discontinued.
Maintenance phase
1. Diet: Long-term dietary control.
2. review blood lipids, liver and kidney function and muscle enzyme profile every six months.
3. Annual check-ups should be performed: plate-motion test (or CT coronary reconstruction), head CT (or MRI), carotid ultrasound, glycated hemoglobin, abdominal ultrasound.