1.What is hyperlipidemia?
Lipids in blood plasma are collectively known as blood lipids, which are substances that supply energy to the body and are mainly composed of cholesterol and triglycerides. Among them, HDL can transport cholesterol out of the body and is called “protective cholesterol”. Most of the other lipid components are higher than normal and may cause a variety of clinical conditions. Clinically, lipids are often measured as the amount of lipoprotein-bound cholesterol or triglycerides in fasting (12 hours or more of fasting) plasma, including: total cholesterol (TC), HDL cholesterol, LDL cholesterol, triglycerides (TG), etc.
Hyperlipidemia is often divided into the following categories depending on the abnormal components of the blood lipids.
(1) Hypercholesterolemia: increased levels of serum TC, LDL, etc.
(2) Mixed hyperlipidemia: serum TC and TG levels are increased.
(3) Hypertriglyceridemia: increased serum TG level.
(4) Low HDL: serum HDL-C level is reduced.
2.Harm of hyperlipidemia
After years of clinical and basic medical research, it has been clearly confirmed that hyperlipidemia is the main risk factor causing atherosclerotic diseases in humans. Common atherosclerotic diseases include coronary heart disease (including myocardial infarction, angina pectoris and sudden death), cerebral infarction and peripheral vascular thromboembolic diseases. These cardiovascular and cerebrovascular diseases have a high incidence, great danger, the progress of the disease is dangerous, and its death rate accounts for about half of the total human mortality, is the first killer of humans!
3, only fat people will have elevated blood lipids?
There is a modern epidemiological study: hypertension, hyperlipidemia, coronary heart disease, diabetes, obesity, etc. collectively referred to as “affluenza”, that is to say, the occurrence of these diseases, in addition to a small number of genetic factors, biological factors, mainly with the improvement of living standards, changes in lifestyle habits, intake and consumption balance imbalance, lack of exercise and other factors closely related. Lack of sports and exercise are closely related to such factors, that is, the negative effects caused by the improvement of living conditions. However, 2/3 of human serum cholesterol is produced by the body itself, and only 1/3 is obtained by diet. Therefore, hyperlipidemia is not entirely a result of eating, and its causes are complex. It can be secondary to kidney disease, diabetes, severe liver disease, etc., or it can be due to family genetic reasons.
4.Causes of hyperlipidemia
Common causes.
(1) High cholesterol: excessive intake of saturated (animal) fat in the diet, liver cirrhosis, poorly controlled diabetes, low A, kidney disease and hereditary hypercholesterolemia.
(2) High triglycerides: excessive caloric intake, alcohol abuse, uncontrolled severe diabetes, kidney disease, certain drugs (e.g. estrogen, etc.) and hereditary hypertriglyceridemia. Hyperlipidemia can be clinically classified as primary or secondary according to its etiology. The latter is caused by other diseases and has a lower incidence. Primary hyperlipidemia may be associated with abnormalities in genes, lipoproteins and their receptors or enzymes. However, hyperlipidemia is also associated with many other risk factors for atherosclerosis.
5.Criteria for lipid control
Lipid control is different from other clinical indicators, and different target populations have different lipid control requirements. Clinicians need to personalize treatment according to the characteristics of different populations. China’s Recommendations for the Prevention and Control of Dyslipidemia stipulate that
1.People without atherosclerotic disease and coronary heart disease risk factors: TC<5.72mmol/L (220mg/d1), TG<1.7mmol/L (150mg/d1), LDL-C<3.64mmol/L (140mg/d1).
2.People without atherosclerotic disease but with coronary risk factors: TC<5.2mol/L(200mg/d1),TG<1.7mmol/(150mg/d1),LDL-C3.12mmol/L(120mg/d1).
3.People with atherosclerotic disease or coronary artery disease: TC<4.68mmol/L(180mg/d1), TG<1.7mmol/L(150mg/d1), LDL-C2.60mmol/L(100mg/d1).
Risk factors for cardiovascular disease include: age (male ≥ 45, female ≥ 55 years old), hypertensive disease, smoking, low HDL-C (< 40mg/dl), family history of early onset coronary heart disease (under 55 years old male immediate family members or under 65 years old female immediate family members with coronary heart disease), etc.
6.Treatment of dyslipidemia
(1) Non-pharmacological treatment measures.
Including diet and other lifestyle modifications for the prevention of hyperlipidemia and the basis of hyperlipidemia treatment. According to recent studies, for every 0.6 mmo1/L (23 mg/dl) increase in total serum cholesterol in the Eastern population, the relative risk of coronary heart disease development increases by 34%. Therefore, prevention and treatment of hyperlipidemia in the Oriental population is one of the most important measures to prevent coronary heart disease.
Dietary therapy: The main nutrients affecting total serum cholesterol are saturated fatty acids and dietary cholesterol, as well as overweight and obesity due to the imbalance between dietary calorie intake and consumption. Therefore, the main components of dietary therapy are to reduce the intake of saturated fatty acids and cholesterol, as well as to control total calories and increase physical activity to achieve caloric balance, and to reduce salt intake to prevent and treat hypertension. This is the first step in the treatment of elevated serum cholesterol, and it should also be carried out throughout the whole process of lipid-lowering treatment (including drug treatment).
(2) Medication.
Because the targets of action of various drugs for treating dyslipidemia are different, and the different individual conditions of patients further determine the individualized treatment plan. Therefore, pharmacological treatment should be carried out under the guidance of a professional clinician.
HMG-CoA reductase inhibitors (statins): used to lower LDL cholesterol. Lovastatin, 10-80mg orally once a night or twice daily; simvastatin, 5-40mg orally once a night; pravastatin, 10-40mg orally once a night; fluvastatin, 10-40mg orally once a night;
Betulinic acid: lower triglycerides and raise HDL cholesterol. Fenofibrate, 100mg 3 times daily or 200mg once daily in particulate form orally; Benzafibrate, 200mg 3 times daily or 400mg in extended release form orally once daily; Gemfibrozil, 300mg 3 times daily or 600mg twice daily or 900mg once daily in extended release form orally;
Niacin: Niacin, 100mg 3 times a day tapered to 1-3g/day orally;
Acipimox: 250mg l-3 times a day orally.
(3) Treatment process monitoring
Review lipid levels 3-6 months after diet and non-lipid-regulating drug therapy, and continue treatment if the requirements can be met, but still review every 6 months to 1 year, or annually if the requirements are consistently met. Review 6 weeks after the start of drug therapy and gradually change to every 6-12 months if the requirements can be met. If the lipid level still does not meet the requirements after 3-6 months of the start of treatment then adjust the dose or drug type and review after 3-6 months and extend to every 6-12 months after the requirements are met and consider adjusting the medication or combination drug type again if the requirements are not met. Adverse effects must be monitored during drug treatment, including liver and kidney function, blood routine and determination of muscle enzymes if necessary.
Elderly: Hyperlipidemia makes the possibility of coronary events in the elderly still exist. The principles of prevention and treatment in adults can be applied to the elderly, but the drug use should pay attention to the dose and side effects, and lipid lowering should not be too drastic and rapid.
Women: Premenopausal women, unless they have serious risk factors, generally have a low incidence of coronary heart disease, so non-pharmaceutical methods can be used to prevent and control, and those with serious risk factors and hyperlipidemia should consider drug prevention and control. Post-menopausal women have an increased chance of hyperlipidemia and a higher risk of coronary artery disease, so they should be treated actively.