Your concerns about cholesterol are all here!

Many readers leave messages on the public account, which has many questions about cholesterol. Because of the time constraints, there is no time to answer everyone's questions one by one. Today, we have gathered the problems that occur more frequently, and then talk to you about cholesterol.

Author: Guo Yifang, People's Hospital of Hebei Province

Source: Guo Yifang Heart Frontier

1

LDL cholesterol is the most important indicator in lipid tests

Many people often care most about triglycerides after getting test orders, thinking that triglycerides are the most important, which is wrong. Among the various blood lipid parameters, the most important thing is low-density lipoprotein cholesterol (hereinafter referred to as LDL-C), which is because the higher the LDL-C, the higher the risk of myocardial infarction and cerebral infarction; the significant reduction of LDL-C, the risk of myocardial infarction and cerebral infarction will be greatly reduced.

2

Is cholesterol bad?

Cholesterol is a substance present in a healthy human body, and whether it is good or bad depends on where it is used. There's a pile of sand along the Huangpu River, and if you build a building with it, it's a good thing; if you push it into the river and block the river, it's bad. The same is true for cholesterol.

Cholesterol is an important substance that makes up cell membranes, synthesizes a variety of hormones, and forms bile acids, which is of course beneficial to our health. But on the other hand, if there is too much cholesterol in the body, when the conditions are available, it will enter the blood vessel wall, form atherosclerotic plaques, and then develop into coronary heart disease, cerebrovascular disease, and even myocardial infarction, cerebral infarction, then it becomes a bad thing.

03

Why lower cholesterol?

As mentioned earlier, cholesterol is the raw material for the formation of atherosclerotic plaques, and atherosclerotic plaques are the basis for the occurrence of myocardial infarction and cerebral infarction, so it is difficult to have myocardial infarction without cholesterol. We all have cholesterol in our blood, and normally we don't enter the walls of blood vessels to form atherosclerotic plaques.

If you suffer from high blood pressure, diabetes, if you smoke regularly, or if you grow older, the integrity of the arterial vascular wall will be destroyed, small fissures will be formed, cholesterol will take the opportunity to enter, and plaques will gradually form. Therefore, we can't let the cholesterol in the blood be too high, and the cholesterol is lowered, and our heart and brain will be safer.

4

It is always said to lower cholesterol, will it be harmful to lower it too low?

Since cholesterol is useful to the human body, it is of course harmful to lower it too low in theory, but the problem is that we do not have the ability to reduce cholesterol to unsafe levels at present. According to the current research results, LDL-C is safe when above 0.5 mmol/L, and this goal is difficult for us to achieve. So at this stage, we don't have to worry about cholesterol being too low.

Based on existing drug and non-drug means, we can think that the lower the cholesterol, the better. If there are really more powerful ways to reduce blood cholesterol to lower levels or even eliminate it all in the future, this argument is not correct.

5

Where does cholesterol come from and where does it go?

This is a bit complicated and requires a few more words.

There are two main sources of cholesterol in the human body: one is synthesized in the body (mainly the liver), accounting for 70%-80%, and the other source is dietary intake, accounting for 20%-30%. Therefore, reducing cholesterol levels should also start from these two aspects, that is, reducing synthesis (mainly by eating statins) and reducing dietary intake (eating less animal brain, egg yolk, quail eggs, fish roe, squid, cuttlefish, fatty meat, animal offal and other foods with high cholesterol).

Where does cholesterol go? One is as bile is excreted into the intestines and then excreted from the stool; the other is that liver cells capture cholesterol from the blood for reuse. These two links are also the site of action of cholesterol-lowering drugs. The newly marketed class of drugs called PCSK-9 inhibitors (such as ilosumab) can increase the liver's ability to reuse cholesterol, thereby significantly reducing blood cholesterol levels; there is a drug called ezetimibu, which can inhibit the absorption of cholesterol in the intestine. Both dietary cholesterol and cholesterol that enter the intestines with bile are absorbed into the body by the small intestine. Taking ezetimibe can inhibit the ability of the small intestine to absorb cholesterol, thereby reducing the level of cholesterol in the blood.

06

After the application of statin, cholesterol still can not drop to the ideal level, what to do?

Statins are the most effective and safe cholesterol-lowering drugs and should be preferred. If cholesterol control is not satisfactory after 1 tablet statin treatment, it is not recommended to increase the dose to 2 tablets and 3 tablets, because the increase in statin dose has very little (about 6%), but the risk of side effects is greatly increased, so the best way is to combine statin with other types of cholesterol-lowering drugs, such as statin combined with ezezerbe, irolizumab or alioximumab, etc. Statin and probuco are also a reasonable option. In patients with severe hypercholesterolemia, a combination of statins, ezezimibe, and PCSK-9 inhibitors may also be considered.

7

After taking lipid-lowering drugs for a period of time, cholesterol is normal, can I stop the drug?

Can't stop! After stopping the drug, cholesterol will rise again, and your cardiovascular and cerebrovascular systems will be harmed again, so be sure to adhere to the medication for a long time.

The greater the amplitude and longer the duration of cholesterol reduction, the smaller the risk of cardiovascular and cerebrovascular diseases. Conversely, the higher the cholesterol level and the longer it lasts, the more likely it is to have a myocardial infarction. Therefore, for hypercholesterolemia, it is necessary to treat it early and treat it for a long time.

8

People with too high cholesterol should be wary of familial hypercholesterolemia!

Familial hypercholesterolemia is a terrible disease that often develops myocardial infarction during adolescence. Such patients often have severely elevated cholesterol (most people have LDL-C above 4.9 mmol/L).

Therefore, if you find a serious rise in cholesterol, you must immediately go to the hospital for examination, and receive intensive treatment in time to try to reduce cholesterol to the lowest possible level.

9

Can atherosclerotic plaques shrink or even eliminate?

It's entirely possible! Many studies (e.g., MARS studies, ASTEROID studies, SATURN studies, FATS studies, ACAPS studies, etc.) have confirmed that the reduction of cholesterol levels through statin or non-statin enhancement can make the already formed atherosclerotic plaque shrink or even disappear.

10

Can blood washing and surgery lower cholesterol?

The scientific name of blood washing is "plasma purification therapy", and this treatment can indeed be effective in lowering cholesterol. But lowering cholesterol is a long-term task, you can't always wash blood at both ends for three days, right? Not to mention the high price, you can't stand it!

So unless necessary (e.g. with multiple drugs cholesterol is still high), it is not necessary to take this approach. As a last resort, severe hypercholesterolemia can also be treated by surgery (removal of a small intestine), but this is also not a conventional treatment.