Over the years, I have often visited township hospitals. Almost every year, I encounter this situation many times: a patient takes out his physical examination results and asks me to see if there is any abnormality in his blood lipids. Why did you ask for lipid-regulating medication? Not only do patients have questions about the above, but some primary care physicians also need insight into the different lipid control goals of different populations. For example, some patients have suffered from cerebrovascular disease or coronary artery disease for many years and have a serum total cholesterol (TC) of 5.6
mmol/L, low-density lipoprotein cholesterol (LDL-C) 2.9
mmol/L. At this time, although there are no abnormal arrows on the checklist, lipid-regulating drugs are still required. Therefore, the decision of whether lipid regulation is needed needs to be made based on an understanding of the patient’s medical history. Lipid control standards vary among different groups of people The normal range of values indicated on the blood lipid checklist we usually see is only the standard suitable for healthy people. For people with atherosclerosis such as cardiovascular disease or people without cardiovascular disease but with risk factors (such as hypertension and diabetes), the lipid requirements are different from those for healthy people. Some lay doctors do not necessarily understand this and therefore fail to give reasonable explanations to patients, resulting in patients who have abnormal blood lipids but do not take appropriate measures in time, leading to the occurrence or aggravation of diseases. The lipid standards for healthy people are as follows: TC 3.0-5.7 mmol/L, LDL-C 2.1-3.1 mmol/L, triglycerides (TG) 0.5-1.7
mmol/L, HDL-C 0.9-1.8 mmol/L. People with atherosclerosis such as cardiovascular disease For this group, TC <4.6 mmol/L and LDL-C <2.6 mmol/L are generally required. Foreign studies
The PROVE-IT study further showed that patients with coronary artery disease can benefit from intensive lipid-lowering therapy with statins as long as they are at high risk for cardiovascular events, regardless of their current clinical status, and that LDL-C treatment targets can be <2.6
mmol/L (100 mg/L) or even up to 1.8 mmol/L (70 mg/L). Our guidelines The Chinese guidelines for the prevention and treatment of dyslipidemia in adults issued in 2007 stipulate that the treatment target for LDL-C in patients with high-risk cardiovascular disease is <2.6 mmol/L (100
mg/L), and for very high-risk patients LDL-C should be <2.07 mmol/L (80 mg/L). What is "high risk" and "very high risk"? For example, a patient with high-risk coronary artery disease is defined as having a diagnosis of coronary artery disease and ≥2 risk factors for cardiovascular disease (note: see below for risk factors for cardiovascular disease), or ≥1 risk factor for diabetes, symptomatic carotid atherosclerosis, abdominal aortic aneurysm, or peripheral artery disease. Patients with very high-risk coronary artery disease, on the other hand, are diagnosed with coronary artery disease and have at least one of the following: (1) diabetes mellitus; (2) uncontrollable heavy smoking; (3) metabolic syndrome; or (4) acute coronary syndrome. For patients with coronary heart disease with diabetes mellitus, it is recommended that LDL-C should be <2.07
mmol/L (80 mg/L). People who do not have cardiovascular disease but have risk factors Generally, for this group, the lipid requirement standard should be between the appropriate lipid range for healthy people and people with cardiovascular disease, etc. Risk factors for cardiovascular and cerebrovascular diseases ① long-term smoking; ② high blood pressure (BP ≥ 140/90 mm Hg); ③ low HDL cholesterol level (<40
mg/dl); ④ family history of early-onset coronary heart disease, i.e. male immediate family members <55 years old with coronary heart disease and female immediate family members <65 years old with coronary heart disease; ⑤ men >45 years old and women >55 years old; ⑥ obese people; ⑦ hypertension. Once dyslipidemia is clearly identified, intervention should be actively carried out Many patients, especially those in rural areas with little health awareness, often do not pay enough attention to dyslipidemia when it does not cause specific symptoms. At this time, primary care physicians should give timely health education. In fact, hyperlipidemia is a “chronic killer” of cardiovascular health. If hyperlipidemia is not controlled for a long time, it is most likely to lead to three types of diseases: first, heart diseases, including cardiac atherosclerosis, coronary heart disease, angina pectoris or myocardial infarction; second, cerebrovascular diseases, mainly cerebral thrombosis and cerebral hemorrhage caused by cerebral vascular sclerosis; third, kidney diseases, renal atherosclerosis can easily cause uremia. For patients without medical knowledge, the most common and simple language can be used to describe that dyslipidemia can “infarction heart”, “infarction brain”. Therefore, it is important to remind those patients who want to control the symptoms only when they appear: some patients with dyslipidemia do not have any precursors and may die at any time, so it is too late to intervene when symptoms appear. The approach to regulating lipids is based on dietary control and initiating statin therapy when appropriate. Statin class lipid regulating drugs include lovastatin, simvastatin, pravastatin, atorvastatin, etc. In addition, the traditional Chinese medicine blood lipid Kang capsule developed in China mainly contains lovastatin, so it can also be included in the statin class. Tip: The subtle harm of high blood lipids to blood vessels must be paid attention to, but the lower the blood lipids, the better. Foreign studies have found that low blood lipids can increase the incidence of tumors. Because cholesterol and triglycerides are essential nutrients for the human body, too much or too little is not good for health.