OVERVIEW
Low-density lipoprotein cholesterolemia (LDLCH) is a condition in which the level of high-density lipoprotein (HDL) cholesterol is lower than normal, with or without elevated levels of cholesterol, triacylglycerol, and low-density lipoprotein (LDL) cholesterol. LDL-cholesterolemia is closely related to the development of coronary atherosclerotic heart disease (coronary heart disease). Genetics is the main factor influencing this disease, and most of them have no specific clinical manifestations, so the diagnosis mainly relies on laboratory tests, and most of them rely on medication, and maintaining good living habits also plays an important role.
Etiology
1. Primary low HDL-cholesterolemia
Genetic predisposition is the main factor influencing the concentration of HDL cholesterol. Low HDL cholesterolemia caused by a significant mutation in a gene is relatively rare in the general population, while most cases of LDL cholesterolemia are caused by non-synonymous mutations in multiple genes, such as familial hypercholesterolemia, Tangier disease, familial mixed hyperlipidemia and so on. Hyperlipidemia, etc.
2. Secondary LDL-cholesterolemia
It is related to acute diseases (e.g. acute myocardial infarction), liver disease, kidney disease, surgery, burns, high-fat diet, smoking, drugs (e.g. β-receptor antagonists), and lack of exercise.
Symptoms
There are no specific clinical signs and symptoms. Depending on the etiology, it may be associated with early-onset cardiovascular disease, xanthoma, obesity and other manifestations.
Examination
Blood biochemical tests show that HDL cholesterol is below 0.91 mmol/L (35 mg/dl), with or without elevated levels of cholesterol, triacylglycerol, and LDL cholesterol.
Diagnosis
Patients with a history of genetic or related diseases, high-fat diet, smoking and other bad habits, mostly with obesity, combined with the blood biochemical examination of HDL cholesterol can be diagnosed.
Treatment
1. General treatment
Including smoking cessation, weight reduction, limiting dietary cholesterol intake, increasing the proportion of unsaturated fatty acids and moderate exercise.
2. Drug therapy
(1) Niacin: It is the most effective drug to raise HDL cholesterol level, which is the longest and cheapest in use.
(2) Statins: the effect of lipid-lowering drugs on HDL cholesterol is small, statins are the first-line drugs to reduce LDL cholesterol, but their role in raising HDL cholesterol is not great.
(3) Beta drugs: the main effect of beta drugs is to lower triacylglycerol and raise HDL cholesterol, but its role in raising HDL cholesterol is related to the level of triacylglycerol.
(4) Others: Intravenous injection of ApoAⅠ can increase excretion in heterozygous patients with familial hypercholesterolemia, suggesting an increase in reverse cholesterol transport in the body.