Foreword: According to relevant data, atherosclerotic cardiovascular disease (ASCVD) has become the primary threat to healthy China, the survey shows that the number of people with dyslipidemia in China is increasing year by year, most of these people have no obvious symptoms, but once the onset of the disease may lead to disability or even death, the study found that in the clinic, although coronary heart disease is more common, it can also be manifested as ischemic stroke (cerebral infarction), chronic kidney disease, etc. Therefore, in order to fundamentally prevent and treat ASCVD, it is very important to actively and carefully manage blood lipids. So, what is dyslipidemia? Is it harmful? How to manage blood lipid health in daily life? In this regard, we invited Liu Junlu, director of the Department of Cardiology of the Yellow River Central Hospital, and asked him to tell us about the relevant knowledge of hyperlipidemia health management, and welcome his arrival!
Highlights of this issue:
Question 1: Director Liu, what is blood lipids? What about high blood lipids?
A: Lipids are a general term for neutral fats (triglycerides and cholesterol) and lipids (phospholipids, glycolipids, steroids) in plasma, which are widely present in the human body. They are essential for the basic metabolism of living cells. In general, the main components in blood lipids are triglycerides and cholesterol, of which triglycerides are involved in the energy metabolism of the human body, while cholesterol is mainly used to synthesize plasma membranes, steroid hormones and bile acids.
Hyperlipidemia refers to high blood cholesterol (TC) and/or triglycerides (TG) or low high density lipoprotein cholesterol (HDL-C), which modern medicine calls dyslipidemia.
The specific diagnostic indicators are:
Total cholesterol: 2.8 to 5.17mmol/L
Triglycerides: 0.56~1.7mmol/L
Cholesteryl lipids: 2.8~5.17mmol/L (110~200mg/dl), accounting for 0.70~0.75 (70~75%) of total cholesterol
HDL: male: 0 .96~1.15mmol/L; Female: 0 .90~1.55mmol/L
LDL: 0 to 3.1 mmol/L
Question 2: Why do you need to start with blood lipid management in the prevention and treatment of atherosclerotic cardiovascular disease?
A: The formation of atherosclerotic plaques in the wall of the arterial canal, resulting in narrowing of the lumen, reducing or even blocking the blood supply to vital organs, is the common underlying pathological change of atherosclerotic cardiovascular disease. Numerous scientific studies have repeatedly confirmed that dyslipidemia, particularly elevated low-density lipoprotein cholesterol (LDL-C), is the most important pathogenic risk factor for the development of ASCVD. Atherosclerotic lipoproteins in the blood enter the walls of the arterial ducts and are necessary for the initial formation and progression of atherosclerotic plaques. Atherosclerotic lipoproteins, although mainly low-density lipoproteins (LDL), also include triglyceride lipoproteins (TRL), such as very low-density lipoproteins (VLDL), residual lipoproteins (RL) and lipoproteins (a) [Lp(a)]. These atherosclerotic lipoprotein abnormalities should be considered the cause or culprit of ASCVD, while other factors associated with the occurrence of the disease (risk factors) such as hypertension, diabetes, smoking, etc. are only accomplices.
Question 3: Many people do not know much about dyslipidemia, what is the concept of dyslipidemia? What are the dangers of dyslipidemia?
A: Concept: Dyslipidemia is a more common type of disease, which is the metabolism of lipoproteins in the human body, mainly including total cholesterol and LDL cholesterol, elevated triglycerides and/or decreased HDL cholesterol. Dyslipidemia is one of the important factors contributing to atherosclerosis and is an independent risk factor for coronary heart disease and ischemic stroke. The incidence of dyslipidemia in China is high, and there is a gradual upward trend, which is closely related to the obvious improvement of the living standards of our people and the change of eating habits.
Harm: At present, people's understanding of the harm of dyslipidemia is still very insufficient, and there are even many misunderstandings. Public awareness of dyslipidemia is low compared to other cardiovascular risk factors, such as hypertension, which are easier to detect and identify. In recent years, many guidelines for the prevention and treatment of dyslipidemia have been published at home and abroad, and they are constantly updated. Raising the awareness of dyslipidemia among the whole people and participating in lipid management is a very important task. In the past 40 years, with the reform and opening up, the way of life of the population in China has undergone great changes, resulting in a significant increase in the level of blood lipids in the whole people. Correspondingly, the incidence and mortality of coronary heart disease in the Chinese population have also increased significantly. As early as the 1980s, 9021 male and female subjects aged 35 to 65 years were followed up in Shanghai for 8 to 13 years, and it was observed that the baseline total cholesterol level in the population was positively correlated with coronary heart disease death, and for every 10% increase in total cholesterol (0.47 mmol/L), the risk of coronary heart disease death increased by 23%. An epidemiological survey of local residents in the Beijing area from 1985 to 1999 showed that there were not many changes in smoking prevalence, diabetes and hypertension rates in the population during this period, the most obvious change was a 24% increase in total cholesterol levels, while the death rate from coronary heart disease among these residents increased by 111%. Attribution analysis showed that among the factors contributing to the increase in mortality from coronary heart disease, the contribution rate of increased blood cholesterol was as high as 77%.
Question 4: Director Liu, what are the benefits of managing blood lipids well?
A: Managing blood lipids can greatly reduce the risk of ASCVD, and a large number of scientific research data confirm that lowering cholesterol levels can significantly reduce ASCVD morbidity and mortality. Sweden has analyzed the reasons for the reduction in the mortality rate from coronary heart disease in 1986-2002 and found that the decline in cholesterol is the main reason for the decrease in coronary heart disease deaths (40%). Finland was once one of the highest mortality rates from coronary heart disease in the world, reaching 4.50 per 100,000, especially among men. Beginning in 1972, Finland implemented the North Carolina Health Promotion Project, which reduced per capita cholesterol levels by about 20 per cent and coronary heart disease mortality by as much as 66 per cent. In addition to actively advocating a healthy lifestyle, it is key to start the correct lipid-lowering drug treatment at the right time. Statins are the most effective drugs for lowering cholesterol levels, especially LDL-C levels. Meta-analysis results showed that for every 39 mg/dl (1.0 mmol/L) reduction in LDL-C, the risk of major cardiovascular events was reduced by 20% and the risk of major coronary events was reduced by 23%.
Question five: It seems that the management of blood lipids has a certain importance to ensure good health, Director Liu, what is the development prospect of managing blood lipid health?
A: Comprehensive management of blood lipids is the direction of clinical exploration, although good efficacy has been achieved by significantly reducing LDL-C or reducing LDL-C to a very low level, but there are still many asCVD risks left. Because atherosclerotic lipoprotein in addition to LDL, also includes VLDL, RL and Lp(a) and the like. To further reduce the residual risk of ASCVD, it is necessary to actively reduce other atherosclerotic lipoproteins other than LDL. Therefore, comprehensive management of blood lipids is the main direction of clinical exploration. Pathological changes in atherosclerosis are a slow and long-term progression process. Managing lipids early in life can be more effective in preventing and reducing the risk of ASCVD.
Question 6: Many patients with hypertension are worried about their blood lipid health, what are the suggestions for the management of blood lipids in patients with hypertension?
A: 1. For patients with grade 1 hypertension, the LDL-C intervention target ≥ 45/55 (male/female) with smoking, obesity, diabetes, hypoHDL-Cemia, carotid plaque and other two items
2. For patients with grade 2 hypertension, LDL-C intervention target LDL-C is LDL-C in patients with age ≥ 45/55 (male/female) combined with smoking, obesity, diabetes, hypoHDL-Cemia, carotid artery plaque, etc
3. For patients with grade 3 hypertension, the LDL-C intervention target should be ≥ 45/55 (male/female).
4. All patients with hypertension should be screened for as early as possible for various ASCVD risk factors such as blood lipids, assess individual ASCVD risk stratification, and determine the target values of blood pressure and lipid reduction. LDL-C intervention targets for ascVD risk stratification in very high-risk patients should be at least 50% lower than baseline, and
Question 7: What are the recommendations for the management of blood lipids in diabetic patients?
A: For the management of blood lipids in diabetic patients, follow the guidelines:
1. Diabetes mellitus with confirmed atherosclerotic cardiovascular disease (ASCVD) is a very high-risk group. LDL-C is at least 50% lower than baseline and LDL-C
2. > 40-year-old diabetes mellitus is a high-risk group, LDL-C is at least 50% lower than baseline, and LDL-C
3. Diabetes mellitus in 20 to 39 years with multiple risk factors (hypertension, dyslipidemia, smoking, obesity, family history of early-onset coronary heart disease) or target organ damage (proteinuria, renal impairment, left ventricular hypertrophy or retinopathy) is at intermediate risk, and LDL-C targets are achieved
4. Lipid-lowering therapy: all diabetic patients should adopt a healthy lifestyle; If lifestyle does not allow lipids to reach targets, moderate-intensity statins are recommended.
5. On the basis of receiving strict lifestyle interventions and statin therapy, diabetic patients not only make LDL-C meet the standards, but also keep TG within the normal range, otherwise, it is recommended to use combination drugs.
Question 8: What are the recommendations for lipid management in PATIENTS WITH ASCVD?
A: 1. For patients with atherosclerotic cardiovascular disease (ASCVD) (stable coronary heart disease, acute coronary syndrome, stroke, transient ischemic attack, peripheral atherosclerotic disease) the target of low-density lipoprotein cholesterol (LDL-C) intervention is
2. For patients with ultra-high-risk ASCVD who have had ≥ 2 severe ASCVD events or 1 severe ASCVD event combined with ≥ 2 high-risk factors. The target of the LDL-C level was to reduce to less than 1.4 mmol/L and more than 50% from baseline.
3. All people with ASCVD should start and carry out lipid-lowering therapy as early as possible and for a long time on the basis of controlling diet and improving lifestyle.
Question 9: Director Liu, in ordinary life, what do normal people need to pay attention to in the management of blood lipids?
A: A retrospective analysis in 2007 showed that a 40%-70% reduction in cardiovascular mortality can be attributed to the control of risk factors, so risk factor prevention and control is the core of the primary prevention of cardiovascular disease and the key to curbing the rising trend of cardiovascular disease. Cardiovascular primary prevention refers to reducing the risk of cardiovascular disease by controlling major risk factors for cardiovascular disease such as smoking, hypertension, dyslipidemia and diabetes before they occur. For example, male/female ≥ 45/55 years of age with smoking or obesity (weight/height square ≥28), an intervention target for LDL-C
In short, the prevention of atherosclerotic cardiovascular disease (ASCVD) should first advocate a healthy lifestyle for the people, followed by the prevention and control of risk factors such as hyperlipidemia, hypertension, and diabetes. Among them, the management of blood lipids is the top priority and is the cornerstone of ASCVD prevention and control.
For patients taking lipid-regulating drugs for the first time, blood lipids, transaminases, and creatine kinase are reviewed before and within 6 weeks of administration. Patients who can achieve the target value of blood lipids and have no adverse drug reactions: gradually change to repeat every 6 to 12 months. Patients with substandard lipids and no adverse drug reactions: monitored every 3 months.
Question 10: Director Liu, you finally give you a popular science, the way to improve abnormal lipid metabolism in life.
A: Limit high-fat foods: All the cholesterol of food comes from animal oil foods, egg yolks, animal offal, roe and brain, etc. contain high cholesterol, should be avoided or used less.
Change the way of cooking: do less oil, try to steam, boil, cold mix, eat less fried food.
Restriction of sweets: Sugars can be converted into endogenous triglycerides in the liver, increasing the concentration of triglycerides in the blood plasma, so the intake of sweets should be limited.
Smoking cessation and alcohol restriction: moderate alcohol consumption can significantly increase the serum hdL lipoprotein and reduce the level of LDL. Therefore, moderate alcohol consumption can reduce the prevalence of coronary heart disease. Alcohol abuse or long-term alcohol consumption can stimulate the liver to synthesize more endogenous triglycerides, causing an increase in the concentration of LDL in the blood and causing hypercholesterolemia. Therefore, middle-aged people are still better off not drinking alcohol. The incidence and mortality rate of coronary heart disease in smokers are 2 to 6 times that of non-smokers, and are directly proportional to the number of cigarettes smoked per day.
Increase exercise: weight loss: For people whose weight exceeds normal standards, they should gradually lose weight under the guidance of a doctor, and it is advisable to lose 1 to 2 kg per month. The dietary principles of weight loss are low in fat, low in sugar, and adequate in protein.
Strengthen physical activity and physical exercise: physical activity can not only increase the consumption of thermal energy, but also enhance the body's metabolism, improve the activity of certain enzymes in the body, especially lipoproteinsterase, is conducive to the transport and decomposition of triglycerides, thereby reducing lipids in the blood.
Psychological adjustment: avoid excessive nervousness: emotional tension and excessive excitement can cause increased blood cholesterol and triglyceride levels.
Speakers:
