Hyperlipidemia is caused by the imbalance of lipid metabolism in human body, it is a pathological state when the concentration of blood lipid exceeds the high limit of “reference value”, without any clinical symptoms, often ending in cardiac, cerebral and peripheral vascular atherosclerotic diseases, with serious consequences, often called “silent killer It is often referred to as the “silent killer”. Clinically, it mainly includes four types of hypercholesterolemia (TC), hypertriglyceridemia (TG), mixed hyperlipidemia and low high-density lipoproteinemia (HDL-C). Therefore, correcting the disorders of lipid metabolism is of great importance to improve the symptoms of coronary heart disease, hypertension and related diseases and reduce the occurrence of cerebrovascular accidents.
The common clinical types of hyperlipidemia are
1, hypercholesterolemia: increased serum total cholesterol content, more than 5.72mmol/L, while triglyceride content is normal, i.e. triglycerides <1.70mmol/L.
2.Hypertriglyceridemia: increased serum triglyceride content, more than 1.70mmol/L, while the total cholesterol content is normal, both total cholesterol <5.72mmol/L.
3.Mixed hyperlipidemia: Both total cholesterol and triglyceride content in serum are increased, i.e. total cholesterol exceeds 5.72mmol/L and triglyceride exceeds 1.70mmol/L.
4.Low HDL-C: decreased serum low HDL-C (HDL-C) content <0.9mmol/L.
In the past 20 years, the worldwide medical community has attached great importance to the research of hyperlipidemia. After a lot of continuous clinical research and observation, more satisfactory efficacy has been achieved in the pharmacological treatment of hyperlipidemia, which is summarized below according to relevant information for the reference of clinicians only.
1.Bile acid chelating agent
These drugs are not easily absorbed orally, mainly by combining with bile acids in the intestine, impeding the reabsorption of bile acids, interfering with the enterohepatic circulation of bile acids, and promoting cholesterol excretion. It is mainly used for the treatment of TC, and can be used for mixed hyperlipidemia if combined with other lipid-regulating drugs.
The representatives of this class of drugs are koleleneamine, koletipo, and hypocholesterolemic glucosamine, etc.; common adverse effects include abdominal distension, mild nausea and constipation, which can be reduced by slowly increasing the dose, taking a large amount of soluble fiber during dosing, and taking drugs that reduce intestinal gas, and can make plasma low-density lipoprotein-cholesterol (LDL-C) fall more significantly. And because it can interfere with the intestinal absorption of certain drugs, it should be taken 1h before or 3h after such drugs when other drugs are taken orally.
2, HMG-CoA reductase inhibitors (also known as statin lipid regulators)
Statins are the most widely used class of lipid-lowering drugs in clinical practice. By inhibiting HMGCoA reductase, the rate-limiting enzyme in the early stage of intracellular cholesterol synthesis, they reduce intracellular free cholesterol, upregulate the expression of LDL receptors on the cell surface, and accelerate the clearance of LDL and VLDL residues in circulating blood. The main clinical indication is hypercholesterolemia, but it is also effective in mild and moderate hypertriglyceridemia. In addition, these drugs have effects beyond lipid regulation by stabilizing endothelial cell function, anti-inflammatory, anti-thrombotic and stabilizing atherosclerotic plaques. Numerous clinical studies have confirmed the efficacy of these drugs for primary and secondary prevention of coronary heart disease, and they have now become the standard of care for patients with coronary heart disease. Conventional doses generally result in a 30% to 40% decrease in plasma TC, a 25% to 50% decrease in LDL-C, a moderate decrease in TG, and a mild increase in HDL-C.
There are various drugs commonly used: simvastatin, lovastatin, pravastatin, fluvastatin, atorvastatin, etc.
The side effects of nausea, poor appetite, bloating, constipation, dyspepsia, headache, insomnia, weakness, rash, myopathy and abnormal liver function appear in a small number of patients after using the drugs, and the symptoms can be reduced or disappeared after reducing the dosage or stopping the drugs.
3.Nicotinic acid drugs
The main effect is to enhance adipocyte phosphodiesterase activity, so that CAMP is reduced, lipase activity is reduced, lipolysis is reduced, plasma free fatty acids fall, liver synthesis of TG and release of LDL is then reduced. At the same time, it inhibits hepatic activity, reduces HDL isomerization, and increases HDL concentration in blood. In addition, it is the only drug that can lower lipoprotein (a), and is suitable for the treatment of any type of hyperlipidemia except familial hypercholesterolemia.
Commonly used drugs include: niacin, leuprolide, inositol nicotinate, etc. Niacin application can cause side effects such as facial flushing, burning or itching of skin, and gastrointestinal symptoms such as loss of appetite, nausea, vomiting, flatulence, abdominal pain and diarrhea, etc. Large doses of niacin can cause peptic ulcer, decreased glucose tolerance, increased blood uric acid and liver damage, etc. Due to the more side effects and slow action of niacin, it has been replaced by many derivatives, such as nicotinic acid inositol ester, which has a moderate and long-lasting effect, except It is used for hyperlipidemia and coronary heart disease, but also for the adjuvant treatment of various peripheral vascular disorders. At present, the most commonly used one is leupeptin, which has a smooth and long-lasting lipid-lowering effect, as well as the function of inhibiting platelet aggregation and improving glucose metabolism, and has fewer adverse reactions and is well tolerated compared with niacin.
4.Fibric acid drugs (also called phenoxyaromatic acid or betablocker lipid regulators)
It mainly enhances the activity of lipoprotein lipase to increase the hydrolysis of TG, which has significant efficacy in the treatment of hyper-TGemia. The earliest clinical use is Antomin, while the more commonly used ones at present are Norhang, fenofibrate, benzofibrate, gemfibrozil and Yidolipid. Adverse reactions mainly include gastrointestinal discomfort, indigestion, transient liver function abnormalities, muscle inflammation; impotence, neutropenia and skin rash.
5.Other lipid-lowering drugs
The main ones are Lipitor, Blood lipid Kang, Gynostemma, Evening primrose oil, etc.
The above summarizes the current domestic and foreign stages of hyperlipidemia treatment, although there are many different kinds of drugs available and different mechanisms, but because lipid-lowering drugs generally need to be taken for a long time, and most of them have adverse effects on liver and kidney function, and there are many adverse interactions with the combination of drugs, so when using them, you should choose the drugs with certain efficacy, suitable price and easy to tolerate, and should strengthen clinical supervision in the use of drugs, and also do not It is not recommended to apply single drug in large doses for a long time to avoid serious side effects.