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Famous Doctor Files
Tang Jiong is the deputy chief physician of the coronary heart disease area of Fuwai Cardiovascular Disease Hospital in Yunnan Province. Ph.D., Department of Cardiology, West China Hospital, Sichuan University. He is the leader of academic technology in Chengdu, the master tutor of Chongqing Medical University, and the deputy director of Chengdu Institute of Central Research.
In the past ten years, nearly 10,000 cases of interventional surgery have been completed. He specializes in cardiac interventional surgery such as coronary heart disease stenting and alcohol chemical ablation of hypertrophic cardiomyopathy, and is engaged in the research of cardiac critical care such as myocardial protection of infarction. He has served as the vice president of the Cardiovascular Branch of the Sichuan Medical Doctor Association, a member of the Standing Committee of the Cardiovascular Branch of the Sichuan Association of Integrative Traditional and Western Medicine, and a member of the Standing Committee of the Cardiovascular Committee of the Sichuan Medical Association.
He has presided over a number of large-scale scientific research projects undertaken by Chengdu Municipal Government, National Health and Family Planning Commission, and Chinese Medical Association
ask
Ziyun: Now there are a lot of people around us who have relatively high blood lipids, especially high blood pressure, high blood lipids, and high blood sugar in the elderly, which are relatively common. And these symptoms will also have a relatively large harm to our body, usually, high blood lipids are the source of all diseases, how should we control the increase in blood lipids?
answer
This is a problem in two ways, on the one hand, cholesterol and excessive intake of high-energy foods. Compared with the intake of our ancestors and predecessors, cholesterol and high energy have increased dozens of times in the past 30 years, but consumption has decreased by dozens of times, and a large amount of excessive intake accumulates in the form of fat in the body, resulting in metabolic disorders and metabolic syndromes.
Here we need to tell you a story about rabbits, rabbits are herbivores, fat intake is intolerant, we need to make atherosclerotic animal models when we do atherosclerotic medical research, that is, to choose rabbits, herbivores, feed it high cholesterol food, generally after 2 months can appear a large amount of lipid deposition in the blood vessel wall, resulting in arteriosclerosis.
The same is true of our human body, in the past hundreds of thousands of human beings have not eaten enough, low-fat intake, manual labor. But in recent decades, after the tide of industrialization, the sudden large intake has overwhelmed our human organism and made it difficult to adapt. On the other hand, this is also the inevitable result of the extension of life expectancy, as the human body grows with age, its metabolic capacity of blood lipids and blood sugar will naturally decline. Therefore, with China's reform and opening up, rapid economic development, and the arrival of an aging population, the rise of blood lipids has become a modern epidemic, which is an inevitable result.
Questions
I have heard that people with elevated blood lipids will have symptoms of cardiac ischemia, but many people with high blood lipids do not seem to have any abnormalities?
Elevated blood lipids do not make patients feel abnormal, so hyperlipidemia is a silent killer. The current cholesterol theory of atherosclerosis has been established, and large-scale clinical trials related to cholesterol in the past 30 years have been proven countless times that there is a direct causal relationship between elevated LDL lipoprotein and atherosclerotic disease, a dose-dependent linear relationship between elevated LDL (low-density lipoprotein) and cardiovascular risk, LDL is the key causative factor and therapeutic target of arteriosclerosis, and the relationship between the two is independent of other cardiovascular risk factors. And the causal relationship between LDL and atherosclerotic cardiovascular disease is also related to the cumulative load of LDL. However, the time period for arteriosclerotic vascular stenosis to produce symptoms of ischemia is long. Because it takes 10 years from the appearance of atherosclerotic plaques to the production of ischemic consequences such as stroke and myocardial infarction, many people mistakenly believe that their blood lipids have been elevated for many years, and they have not felt anything, so as to take it lightly and relax the control and management of their own blood lipids.
So if patients with coronary heart disease reduce their blood lipids to normal, can they restore their health?
If we reduce LDL lipoprotein by more than 50% in patients with coronary heart disease, we can stabilize the atherosclerotic plaque, and the plaques of some patients with early atherosclerosis can also retract to restore blood vessels to health.
LDL is a linear relationship with atherosclerosis, and for every 1 mmol/L (38.7 mg/dl) reduction in our LDL, the risk of large vascular events is reduced by 21%, and the lower the LDL level after statin therapy, the more stable the atherosclerotic plaque structure is. If primary prevention: LDL-C decreases by 1 mmol/L, the incidence of events decreases by 1.5%, and secondary prevention: LDL-C decreases by 1 mmol/L, the incidence of events decreases by 4.6%.
Our deep understanding of cholesterol in the past decade has greatly changed our understanding of the treatment of coronary heart disease, which is reflected in china's clinical guidelines: 2007 guidelines for the treatment of patients with coronary heart disease: LDL-C<2.07 mmol/L (80 mg/dl); TC < 3.11 mmol/L (120 mg/dl), 2016 guidelines for the treatment of patients with coronary heart disease: LDL-C<1.8 mmol/L (70 mg/dl), If the LDL-C baseline value is high, if it is difficult to reduce LDL-C to the basic target value after 3 months of standard treatment with existing lipid-modifying drugs, LDL-C should be reduced by at least 50%, and LDL-C should still be reduced by 30% in very high-risk patients with LDL-C baseline below the target value. From the above changes in lipid guidelines, we can see that our requirements for lowering cholesterol in patients with coronary heart disease are becoming more and more stringent.
What is the current lipid status in our country or Yunnan Province?
The overall prevalence of dyslipidemia in Chinese adults in 2016 was as high as 40.40%, a significant increase compared with 2002. It is speculated that the increase in serum cholesterol levels in the population will lead to an increase of about 9.2 million cardiovascular disease events such as coronary heart disease in China between 2010 and 2030. Among the risk factors for death from coronary heart disease in China, cholesterol is the closest, accounting for 77% of the weight.
2017 Cardiovascular Health Index National Ranking: Yunnan Province high blood lipids and other cardiovascular risk factors in the country in the third high level, if not controlled, a few years later in Yunnan Province coronary heart disease, myocardial infarction explosive growth will soon come.
If we insist on not eating meat every day and strictly controlling cholesterol intake, can eating more vegetables reduce blood lipids?
This is a misunderstanding of the lipid-lowering treatment of coronary heart disease, and cholesterol is a substance that we need physiologically. In the body, it can be used as an important component of the cell membrane, in addition, it can also be transformed into a variety of substances with important physiological effects, in the adrenal cortex can be converted into adrenal corticosteroids; in the gonads can be converted into sex hormones, such as androgens, estrogen and progesterone; in the skin, cholesterol can be oxidized to 7-dehydrocholesterol, which is often converted into vitamin D3 by ultraviolet radiation; in the liver, cholesterol can be oxidized into bile acids to promote the digestion and absorption of lipids.
The human body needs about 1000mg of cholesterol every day, dietary intake accounts for about 20% to 30%, the rest need to be synthesized autonomously through the liver, under a normal diet, normal people contain about 300-500mg of cholesterol in their daily diet, mainly from animal offal, egg yolk, cream and meat, people consume less cholesterol from food than the human body needs every day, most of them need to be synthesized by the human body, it can be said that the correlation between dietary cholesterol and blood lipids is not particularly obvious. Therefore, if you want to control the total cholesterol level of the body, simply eating less cholesterol is basically ineffective.
On the contrary, strict restrictions on the intake of meat and eggs are harmful to body nutrition. Of course, the fact that the American Nutrition and Dietary Association has eliminated the 300 mg daily intake limit does not mean that cholesterol is "good" and can be ingested without restriction. In general, 2/3 or greater of the cholesterol in the blood is synthesized in the human body, and the cholesterol ingested by the diet is part of the factor of increased cholesterol in the human body, and more importantly, the metabolism in the body.
The real prevention of arteriosclerosis is the Mediterranean diet
The Mediterranean diet represents a healthy, simple, light and nutritious diet, supplemented by olive oil and nuts. 2014 PREDIMED study: This Mediterranean diet can significantly reduce the risk of peripheral arterial disease by 20-30%.
Lowering cholesterol requires good lifestyle habits in conjunction with statin-based lipid-lowering drugs to achieve good results.
First, eat healthy. Eat a reasonable diet and reduce the intake of foods with high cholesterol. In fact, most of the cholesterol is synthesized by the human body itself, so in the middle of the diet, special emphasis is placed on low calories, low sugar, and low salt to achieve a reduction in overall calories.
Second, exercise appropriately. Exercise can burn calories, exercise at least 5 days a week, exercise for half an hour a day, and control weight.
The third is to improve the bad lifestyle, including smoking cessation, alcohol restriction, control the rhythm of life, do not over-stress, stay up late, etc., a healthy lifestyle is an important basis for controlling cholesterol.