Many people have heard of the three highs and know the disadvantages of hypertension and high blood sugar: severe hypertension can cause stroke, myocardial infarction, kidney failure, etc.; Diabetes mellitus (long-term high blood sugar) causes chronic damage and dysfunction of the eyes, kidneys, heart, blood vessels, and nerves. But what is the other high?
Many people are not clear. That is, high blood lipids, the harm to people should not be underestimated. High blood lipids can lead to a series of worrying diseases such as obesity, cardiovascular, liver disease, and kidneys. What causes hyperlipidemia? You're right, it's cholesterol, is cholesterol all bad? How to lower cholesterol? Let's talk to you today!
01, Is cholesterol all bad?
Lipids are a general term for cholesterol, triglycerides, and lipids in serum [1], and if cholesterol levels are increased, dyslipidemia may occur [1].
But is cholesterol completely out of the good side? You can't kill with a stick. Cholesterol in the human body is divided into two types: high-density lipoprotein cholesterol (HDL-C), commonly known as "good cholesterol", and low-density lipoprotein cholesterol (LDL-C), commonly known as "bad cholesterol". Where the specific "good" and "bad" are, look at the figure below to see at a glance.
"Good" cholesterol reduces blood vessel blockage, while "bad" cholesterol keeps making bad and clogging blood vessels.
The consequence of "bad" cholesterol is that blood cannot pass through blood vessels. (Image source: Sohu)
How to distinguish between good and bad cholesterol? Tests are usually labeled HDL-C (good cholesterol) and LDL-C (bad cholesterol). If LDL-C is elevated. It is necessary to pay attention to it and sound the alarm. But don't panic, regularly carry out blood lipid tests, if cholesterol is high, prevent and treat it as soon as possible.
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Let's talk about what value of the specific "bad" cholesterol is, it is really "bad", that is, what are the prevention and control standards?
02, What are the prevention and control standards for cholesterol?
For the general population (people with primary prevention of ASCVD), refer to the following figure:
Guidelines for the prevention of dyslipidemia in adults in China 2016 revised edition[1]
However, for those with a history of atherosclerotic cardiovascular disease (ASCVD) (including coronary heart disease, stroke, peripheral vascular disease, etc.), the goal of cholesterol control is different:
Guidelines for the prevention of dyslipidemia in adults in China 2016 revised edition[1]
For example, a 2015 IMPROVE-IT study found that LDL-C decreased from 1.8 mmol/L (69.5 mg/dl) to 1.39 mmol/L (53.7 mg/dl), and the risk of cardiovascular events could be further reduced [2].
03, How to lower cholesterol?
Personally, I think it is mainly from two aspects:
1. Diet therapy and lifestyle changes. Does diet affect cholesterol? That's for sure. Changes in dietary patterns and increased intake of animal foods are indisputable facts of elevated cholesterol.
However, current research has proved that the relationship between blood cholesterol and dietary cholesterol is not close, so the US Dietary Guidelines and the "Dietary Nutrient Reference Intake for Chinese Residents" no longer simply limit the intake of dietary cholesterol, but emphasize balanced diet, balanced nutrition, and change unhealthy living habits [3]-[4].
Willett Healthy Diet Pyramid
Two. Statin therapy. Lipid-lowering drugs of statins have a very good effect on the primary and secondary prevention of cardiovascular diseases, and can significantly reduce the risk of cardiovascular disease.
Statin is slightly less effective in the treatment of some high-risk patients [5], and it can cause liver, muscle and other related adverse reactions in people who are intolerant. There is also a "statin efficacy 6% effect" or "statin 6 principle", which states that the dose of statin drugs is doubled, and LDL-C is further reduced by only about 6% [1].
[6]-[7]
04, what should I do if statin drugs cannot achieve cholesterol levels?
If statin drugs cannot achieve cholesterol standards, a combination of statins and ezetimibe can be tried, which has a good lipid-regulating effect. Studies have shown that this method can reduce blood lipids by about 18% on the basis of statin therapy [1]. However, a significant proportion of patients who have received lipid-lowering therapy do not meet their cholesterol levels [8].
Now there is an innovative and highly safe biomonoclonal antibody drug on the market, which can solve the bottleneck problem of traditional cholesterol-lowering drugs, which is PCSK9 inhibitors. It can reduce LDL-C levels by an additional 50 to 60 percent in addition to statin therapy [9].
How does it do it? It's about introducing a "good guy" in the blood: the low-density lipoprotein (LDL) receptor (LDLR). "Good-guy" LDLR clears "bad" cholesterol [10]. But once PCSK9 and LDLR are combined, "bad" cholesterol is difficult to eliminate. Therefore, PCSK9 inhibitors are sent to inhibit PCSK9 binding to LDLR and control overall levels of "bad" cholesterol [10].
This PCSK9 inhibitor, which protects the "good" and clears the "bad" cholesterol, significantly reduces LDL-C levels and improves other lipid profiles, with a favorable safety profile [11]. A study called FOURIER showed that LDL-C levels could be reduced to very low levels and cardiovascular events when treated with PCSK9 [12].
So, does high cholesterol matter? This focuses on the value of "bad" cholesterol (LDL-C), which is an important risk factor for cardiovascular disease; How to lower cholesterol? Going to bed early and getting up early, eating healthily, and exercising your legs are the basics. If necessary, consult a doctor to see if it is to be adjusted with medication.
It is worth adding that at the 2017 ACC (American College of Cardiology) Asia Pacific Congress, Professor Anthony Keech announced that PCSK9 inhibitors are equally effective in reducing the risk of cardiovascular events in Asian populations and have comparable safety data compared to other populations [13]. Patients in need can consult their doctor.
[1] Chinese Joint Committee for the Revision of Guidelines for the Prevention and Treatment of Dyslipidemia in Adults. Guidelines for the prevention and treatment of dyslipidemia in adults in China (2016 revised edition) [J] . Chinese Journal of Cardiology,2016,44( 10 ): 833-853. DOI: 10.3760/cma.j.issn.0253-3758.2016.10.005
[2] Outpatient Magazine. Peng Daoquan: Analysis of the perspective and practical strategy of "LDL-C is lower and better". New Horizons in Outpatient Clinics, 2017.
[3] U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015.
[4] Health Communication Branch of Chinese Preventive Medicine Association, Chronic Disease Prevention and Control Branch of Chinese Preventive Medicine Association, etc. Correct Understanding of Cholesterol Science Statement, 2016: 3.
[5] Aggarwal J, et al. Abstract from AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016, April 19-22 2016; San Francisco, CA.
[6] Knopp RH. N Engl J Med. 1999;341 (7):498-511.
[7] Stein E. Am J Cardiol 2002;89(5A): 50C-57C.
[8] Zhao S, Wang Y, et al., Prevalence of dyslipidaemia in patients treated with lipid-lowering agents in China:results of the DYSlipidemia International Study (DYSIS), Atherosclerosis (2014), doi: 10.1016/j.atherosclerosis.2014.05.916
[9] Sabatine MS, Giugliano RP, Keech AC et al. Evolocumab and Clinical Outcomes in Patients with.
[10] Shen Li, Zhao Pingping. Research status of PCSK9 inhibitors, a new lipid-lowering drug[J]. Chinese Journal of Internal Medicine, 2013, 52(7):27-28.
[11] Effect and safety of PCSK9 inhibitors in the treatment of familial hypercholesterolemia. DOI: 10.3969/j.issn.1002-266X.2016.46.014.
[12] Outpatient Journal. Peng Daoquan: The lower the LDL-C level, the lower the ASCVD risk, and no failure threshold has been found. New Horizons in Outpatient Clinics, 2018.
[13] FOURIER Study Asian Population Analysis Published!. Cardiovascular Remote Platform, 2018.