1. How to determine the treatment of hypercholesterolemia based on risk factors? How should I actively intervene with cholesterol? Long-term studies have shown that the more risk factors there are, the greater the likelihood of heart disease leading to myocardial infarction and stroke. Most risk factors such as smoking, hypertension and diabetes can be modified, controlled or even eliminated; some risk factors such as age and genetics are not modifiable. Numerous clinical studies over the past 20 years have shown that lowering LDL cholesterol can significantly reduce the risk of future myocardial infarction, mortality from coronary heart disease, interventions (coronary angioplasty and stenting) and coronary artery bypass grafting (CABG), even with risk factors and risk factors that contribute to the risk of myocardial infarction or a high risk of myocardial infarction. Controlling risk factors such as smoking habits, hypertension, overweight and diabetes is often difficult, but even if the above risk factors are not modified, aggressive control of cholesterol levels in patients with these risk factors can help reduce their risk of cardiovascular disease overall. For this reason, and because cholesterol levels can be effectively lowered with medications and diet, more aggressive cholesterol reduction goals are currently recommended in people with multiple risk factors. Most current guidelines recommend that the ideal cholesterol level should be below 100 mg/d for all adults, but the National Cholesterol Education Program (NCEP) specifically recommends that cholesterol-lowering therapy should be initiated in adults with no or only one risk factor and LDL cholesterol ≥ 160 mg/dL. In patients diagnosed with coronary artery disease (or equivalent risk factors such as diabetes), the target LDL cholesterol therapy should be ≤100 mg/dL; in the highest risk patients, with both coronary artery disease and additional risk factors, consideration should be given to encouraging physicians to lower cholesterol to ≤70 mg/dL. dL levels. Are these very low LDL cholesterol level values healthy and safe for us? The usual expert response to this question is that because we are born with LDL cholesterol levels of 30 mg/dL, a target LDL cholesterol value of 70 mg/dL is perfectly safe and healthy. To date, no large-scale clinical trials on cholesterol treatment have shown any indication that the above conjecture is not true. 2. What are the genetic factors that cause lipid metabolism disorders? Many inherited disorders of lipid metabolism called lipid abnormalities or hyperlipidemia have been identified, and the relationship between genetics and human disease is a very active area of research at this time. Familial hyperlipidemia is an important cholesterol-related disorder. The disease is usually inherited in an autosomal dominant manner – that is, the disease can be passed from one affected parent to the next. The prevalence of the disease is about 1 in 500 in the population, and patients usually have LDL levels that are more than twice as high as normal. Early onset heart disease, both in men in their 30s and in women in their 40s, is seen in many families with familial hyperlipidemia. If both parents are familial hyperlipidemic, 1/4 of their children are likely to inherit two abnormal genes that will produce extremely high LDL cholesterol levels and develop heart disease at a very early age, requiring combined dietary and pharmacological treatment. Some patients with familial cholesterolemia require LDL plasma exchange, which involves drawing blood out of the body in an arterial vein, filtering out the excess LDL cholesterol, and then returning the blood to the body through another vein. This procedure, which takes 2 hours each time, is performed every 1 or 2 weeks. Other genetic conditions can cause elevated cholesterol and triglycerides, elevated cholesterol alone and elevated triglycerides alone. Low HDL cholesterol levels can be part of other inherited disorders of lipid metabolism or can occur alone (isolated hypoHDLemia). High lipoprotein a levels (Lp(a), see question 29) are an additional risk factor for heart disease and are also inherited. In addition, some individuals have a genetic profile characterized by low levels of LDL cholesterol, and such individuals have a lower risk of heart disease.