What are dyslipidemia? The term “lipid” refers not only to triglycerides in the blood, but also to cholesterol and other lipids. Cholesterol and triglycerides must bind to specific proteins in the blood in order to be transported in the blood, which are the various “lipoproteins” we see on lab tests. Elevated plasma cholesterol or triglycerides and lower HDL cholesterol are considered dyslipidemia, or what is often referred to as “hyperlipidemia”. Cholesterol includes low-density lipoprotein cholesterol (LDL), which is called “bad cholesterol,” and high-density lipoprotein cholesterol (HDL), which is called “good cholesterol.” An increase in LDL can cause atherosclerosis, so it is called “bad cholesterol. “HDL, on the other hand, has an anti-atherosclerotic effect as it transports excess cholesterol away from the arteries, reduces LDL and prevents it from being deposited in the blood vessel walls. This is why it has been given the title of “good cholesterol”. The full range of lipid tests includes not only cholesterol and triglycerides but also lipoproteins. How do dyslipidemia cause stroke? During outpatient visits, we often encounter patients who are very anxious and nervous when a very small brain infarct lesion is found on cranial MRI, thinking that they will be paralyzed soon, while paying no attention to dyslipidemia. It is because of the long-term effect of risk factors such as dyslipidemia, hypertension and smoking that cause stroke. People with dyslipidemia often do not have any symptoms, so it is called the “silent killer”. See how this silent killer works: the “bad” cholesterol in the blood rises to a certain level, and when the endothelium of blood vessels becomes abnormal, the “bad” cholesterol enters and accumulates in the artery walls. The bad cholesterol is deposited on the artery walls and gradually forms atherosclerotic plaques after accumulation. Plaque is like scale in a kettle, if it is allowed to be deposited but not taken care of, it will accumulate more and more over the years. The surface of the plaque is a layer of envelope, which is compared to the skin of a dumpling, and the inside is a collection of lipids, like the trap of a dumpling. As the plaque grows inside the vessel wall, the lumen of the artery will become narrower and narrower, which will affect the blood flow and eventually develop into a blockage. Even if the plaque is not large, the “bad” cholesterol can cause inflammation and make the membrane on the surface of the plaque thin, and the thin “dumpling skin” can easily rupture. The thin-skinned plaques are “unstable plaques”, which can rupture without any aura, like time bombs lurking in the blood vessels that can explode at any time. What should I do if I find dyslipidemia? First of all, we should know what causes dyslipidemia, and then we should choose the way to deal with the cause. The causes of dyslipidemia include: excessive fat, cholesterol or calories in daily diet; too little physical activity or physical exercise; age over 50; obesity; irregular life, emotional excitement and tension; smoking; excessive alcohol consumption; low thyroid function; liver, kidney disease, diabetes, hypertension, etc.; early-onset dyslipidemia or coronary heart disease in the family. From the above reasons, we can see that besides some diseases and genetic factors, poor lifestyle is an important acquired factor that causes dyslipidemia. Therefore, it is necessary to change the bad lifestyle first and control the total amount of meals eaten. Eat a low-fat, low-sugar and low-salt diet, and eat more vitamin-rich foods. Quit smoking and limit alcohol. In addition, you should also increase the amount of exercise, adhere to regular exercise. That is, people often say “keep your mouth shut, open your legs”. It is worth noting that even medication should be implemented on the basis of diet and lifestyle, which is like building a house with a foundation. Statins are the most effective drugs for lowering cholesterol and preventing cardiovascular disease. Statins significantly lower “bad” cholesterol, and in addition have anti-inflammatory and endothelial protective effects, all of which are associated with stroke prevention. During drug treatment, blood lipids and liver function should be checked regularly and the dosage should be adjusted under the guidance of the doctor. Some dyslipidemia due to disease or genetic reasons requires lifelong medication. Because the cause of the dyslipidemia cannot be removed, once the medication is stopped, the “bad” cholesterol will rise again and damage the blood vessels. What is lipid control? We often say that “control of risk factors must meet the standard”, without which it is difficult to achieve the goal of prevention. What is the measure of compliance? Does it mean that the blood lipids are within the normal range of the laboratory test? It is not that simple, because each person has a different risk of stroke, and the higher the risk, the greater the effort to save. For people without atherosclerosis, it is sufficient to control the lipids within the normal range. For people who have already had a stroke due to atherosclerosis, LDL should be below 2.6 mmol/L. If the cause of stroke is caused by unstable plaque or accompanied by any of the following risk factors: diabetes, coronary heart disease, metabolic syndrome, continuous smoking, these people are at greater risk of having another stroke and are an extremely high-risk group, and LDL should be controlled below 2.1 mmol/L to reach the standard. According to a survey, there are 160 million people with dyslipidemia in China, and the control rate is only 26.5%. Stroke is completely preventable, but it requires knowledge to be translated into action and active public participation. When everyone has the knowledge to control every risk factor that causes stroke, including dyslipidemia, it is possible to get rid of stroke and live a healthy and happy life.