In the past two days, another young man died of a sudden heart attack. The China Cardiovascular Disease Report states that China has about 290 million patients with cardiovascular diseases, including coronary heart disease, stroke, heart failure and hypertension, and that cardiovascular disease is the leading cause of death. Hyperlipidemia, commonly known as hyperlipidemia, is one of the main causes of cardiovascular diseases. Studies in the last 20 years or so have shown that cardiovascular morbidity and mortality can be significantly reduced through the prevention and treatment of hyperlipidemia, especially hypercholesterolemia. What are the sources, main components and role of blood lipids in the body? Blood lipids, a general term for neutral fats and lipids in the blood, are widely found in the human body and are essential for life. In general, however, clinical references to lipids refer mainly to triglycerides and cholesterol. Triglycerides in the blood are involved in the energy metabolism of the body and provide energy for life, mainly from food. In contrast, cholesterol is an important raw material for the synthesis of cell plasma membranes, steroid hormones (including vitamin D, etc.) and bile acids, which are mainly synthesized by the body’s cells themselves. Liver cells play an important role in the synthesis of cholesterol. Therefore, although dietary control is an important measure for hyperlipidemia, it is more effective for hypertriglyceridemia by comparison. Are there good and bad blood lipids? Blood lipids have important physiological functions and are essential for life. However, lipids may have bad effects in the following two situations: (1) “Too much”: When the level of cholesterol or triglycerides in the blood exceeds the physiological requirements, lipids can play a normal physiological role while also “causing trouble”, such as promoting Coronary heart disease, pancreatitis, etc. (2) “Wrong train”: Both triglycerides and cholesterol cannot be dissolved in the blood, but must “take a ride” before they can play a role in the human blood circulation. The “car” here is lipoproteins. In clinical practice, the main focus is on four types of lipoproteins: celiac, very low density lipoprotein, low density lipoprotein and high density lipoprotein, especially the last two lipoproteins have received much attention in recent years. The cholesterol that “rides” on LDL is called LDL-C and the cholesterol that “rides” on HDL is called HDL-C. LDL is the cholesterol transported to the blood vessel wall, promoting the formation of atherosclerotic plaque, which will block the blood vessel and lead to coronary heart disease and stroke. HDL, on the other hand, transports cholesterol from the plaque outward, so that the plaque is less likely to grow. That’s why LDL-C is the “bad” cholesterol and HDL-C is the good cholesterol. How can I know if my blood lipids are normal? The four indicators are total cholesterol, triglycerides, HDL-C and LDL-C. Currently, the main method used is to take a blood test on an empty stomach. It is recommended that you maintain your usual diet and weight for 2 weeks prior to the blood test, refrain from strenuous activity the day before the blood test, and rest for at least 5 minutes after fasting for 12 hours before sitting down for the blood test. Checking the above 4 indicators is an important step to understand the level of blood lipids, but you should not rest on your laurels just because your blood lipid level is within the normal range on the lab report. You should ask your doctor to make a comprehensive judgment based on your blood lipid level, age, gender, whether you smoke or not, and whether you have high blood pressure or diabetes. How should “regular blood tests” be performed? Regular blood lipid check is the foundation of cardiovascular disease prevention and treatment. For healthy people, lipid testing should be done at least once every 5 years when they are younger than 40 years old, and once a year for men over 40 years old and post-menopausal women. For people at high risk of cardiovascular disease and those with existing cardiovascular disease (coronary heart disease, cerebrovascular disease or peripheral atherosclerosis), it is recommended to test once every 3 to 6 months. People at high risk for cardiovascular disease include those with multiple cardiovascular risk factors (such as hypertension, diabetes, obesity, smoking, etc.); those with a family history of early-onset cardiovascular disease or a family history of hyperlipidemia; and those with xanthogranuloma. What is the etiology of dyslipidemia? What are the clinical manifestations? The etiology of hyperlipidemia is divided into two categories: primary and secondary. Primary hyperlipidemia mainly refers to dyslipidemia caused by mutations in genes involved in lipid metabolism, such as familial hypercholesterolemia. Secondary hyperlipidemia is the most common type of dyslipidemia, and refers to dyslipidemia caused by adverse lifestyle habits, drugs and diseases. Poor lifestyle habits include unscientific dietary structure (large fish and meat or very low fat intake), excessive alcohol consumption, lack of exercise, and obesity. In addition, diabetes, hypothyroidism, nephrotic syndrome, liver disease and certain medications can also lead to dyslipidemia. What are the dangers of hyperlipidemia? The dangers of hyperlipidemia involve both cardiovascular and non-cardiovascular systems. Hyperlipidemia, especially hypercholesterolemia, is the most important risk factor for atherosclerosis. Once atherosclerosis occurs in large and medium-sized arteries, stroke, myocardial infarction, ischemic kidney disease, and in severe cases, sudden death can occur. In addition, severe hypertriglyceridemia can lead to acute pancreatitis, fundus venous thrombosis and other diseases. What are the symptoms of hyperlipidemia? The clinical manifestations of hyperlipidemia are mainly the manifestations of its comorbidities, which can be simply divided into those of the cardiovascular system and those of the non-cardiovascular system. Patients with stroke can have speech impairment and hemiplegia; coronary heart disease can have angina pectoris and heart failure; severe renal atherosclerosis can also lead to kidney failure. Some patients may also show intermittent claudication. The main non-cardiovascular system is skin xanthoma, abnormal vision, pancreatitis, etc. How is hyperlipidemia treated? The treatment of hyperlipidemia consists of 3 main areas: therapeutic lifestyle improvement, medication and others. When implementing treatment it must be clear that the goal of hyperlipidemia treatment is not just to bring down blood lipids, but to prevent and delay the onset and progression of ischemic cardiovascular disease so that patients can live better and live longer. Therapeutic lifestyle improvement is the most important and fundamental measure for the prevention and treatment of hyperlipidemia, which is safe and effective. The diet should be different from person to person, scientific mix, avoid big fish and meat, but also do not advocate “no oil”, can drink moderate amount of alcohol, daily ethanol intake of men not more than 20 grams ~ 30 grams, women not more than 10 grams ~ 20 grams. To maintain body weight, generally speaking, the body mass index of Chinese people should be controlled at 18~24, calculated by the formula of weight (kg)/height squared (m). Roughly estimate the appropriate weight is: appropriate weight (kg) = height (cm) – 105. advocate moderate exercise, especially aerobic exercise, the amount of exercise gradually, depending on the person, it is best to integrate into the work and life. In addition, it is important to quit smoking, maintain a good state of mind and sleep. At present, the main lipid-regulating drugs in the Chinese market are statins, cholesterol absorption inhibitors, fibrates, niacin and bile acid simulants, the first three of which are more commonly used. Statins are the first choice for the prevention and treatment of hyperlipidemia and atherosclerosis, mainly by inhibiting the synthesis of cholesterol in the body to reduce blood cholesterol concentration, and it is recommended to take them at night before going to bed. In severe hypercholesterolemia, if statins are not effective, they can be combined with ezetimibe, a cholesterol absorption inhibitor. Betablockers are mainly used to lower blood triglyceride concentrations and are recommended to be taken with meals. In addition, herbal medicines and fish oil products are available. Lipoprotein plasma exchange and liver transplantation are also means of treating severe hyperlipidemia, but these two treatments are rarely used at present due to the complexity of the methods, the many comorbidities, and the widespread use of potent lipid-lowering drugs in clinical practice. Prevention is the most critical tool for any disease. How to prevent hyperlipidemia? The first thing is to have a scientific lifestyle, “keep your mouth shut, open your legs”, eat in moderation, maintain a proper weight and exercise moderately. In addition, we should actively treat diseases that can cause hyperlipidemia, such as diabetes, hypothyroidism, nephrotic syndrome and liver disease, monitor changes in blood lipids, take timely countermeasures and avoid drugs that can interfere with lipid metabolism as much as possible. What else do you think needs to be emphasized about this topic? Three key tips: first, hyperlipidemia is a silent killer and must be taken seriously; second, prevention is the main focus and regular checkups; and finally, prevention and treatment of hyperlipidemia are recommended under the guidance of a doctor.