Patients often come with test sheets, and their triglycerides are a little high, and they are very anxious. What should I do if my blood lipids are high? Do I need to take medicine? Some people even took medicine. However, I don’t care if cholesterol is high, because I don’t think cholesterol is blood lipids.
Actually, cholesterol is also a blood lipid and the most important part of it. Three of the four lipid disorders are clearly related to abnormal cholesterol: hypercholesterolemia, low-density lipoproteinemia strong>, and mixed hyperlipidemia with high cholesterol and triglycerides; is hypertriglyceridemia, which is also related to cholesterol, because it will Exchange with cholesterol. Besides, cholesterol also has “fat” in it! High-density lipoprotein cholesterol, low-density lipoprotein cholesterol, protein and lipid combined!
So, let’s talk about four things in blood lipid lowering treatment.
The first thing, the most important thing in lowering blood lipids is lowering low-density lipoprotein cholesterol. How high is “low density” to be lowered?
Low-density lipoprotein cholesterol is an important culprit in atherosclerosis, and reducing low-density lipoprotein cholesterol has become an important basic treatment for the prevention of atherosclerotic cardiovascular disease. Practice has proved that by reducing “low-density” cholesterol, the progression of atherosclerosis will be curbed, delayed, or even possibly reversed.
It should be noted that blood cholesterol is not high, not only based on the normal value on the test sheet, but also based on whether the patient’s cardiovascular disease is serious or not. The degree is high to judge and grade.. The normal value on the test sheet is for normal people and people without cardiovascular disease.
In this way, if the cardiovascular risk is not high, the cholesterol is controlled within the normal range for the average person. As cardiovascular risk increases, the criteria for ‘low density’ fall below normal. Such as hypertension or diabetes, atherosclerosis, and other risk factors, the assessment is high risk, and low density should be controlled below 2.6mmol/L; already have coronary heart disease, cerebrovascular disease, etc., that is very high risk, control below 1.8mmol/L; if repeated myocardial infarction and stent placement, If you have myocardial infarction and cerebral infarction, or have high blood pressure, diabetes, myocardial infarction, or stent, that is ultra-high risk, and it should be reduced to 1.4mmol/L Below.
The second thing, the most recognized blood lipids, should I treat high triglycerides?
Simply put, Three lines are drawn to distinguish between three cases.
The first type, triglyceride is higher than the normal value, but lower than 2.3 (2.25) mmol/L, no need for medication.
Second, triglyceride is particularly high, exceeding 5.7 (5.65) mmol/L, and medication is generally required. Because blood lipids are too high, it will cause acute pancreatitis, which is a risk.
The third type, triglycerides between 2.3 mmol/L and 5.7 (5.65) mmol/L, depends on the specific situation of the patient.
The result of high triglycerides will also aggravate high cholesterol, so it still depends on the level of cholesterol, and the priority of treatment is to lower cholesterol.
Patients with coronary heart disease should lower their cholesterol first. Cholesterol has dropped, but triglycerides are still high, so it needs to be lowered. Because at this time high triglycerides will increase the residual cardiovascular risk. However, special attention should be paid to adverse reactions when combined with statins.
In people with diabetes, high triglycerides are associated with high blood sugar because sugar “turns” into lipids. Generally, the blood sugar is controlled and the triglycerides will be reduced.
Triglycerides are closely related to diet. It is very important to keep your mouth shut, avoiding high-sugar, high-fat and greasy diets, and exercising to lose weight will help reduce triglycerides.
If the triglyceride levels are always near the upper limit and cannot be lowered by improving the lifestyle, you can take medicine.
The third thing, what to do with low HDL cholesterol?
Everyone knows that cholesterol is “higher if it’s high and lower if it’s low”, and some people are worried about the low HDL cholesterol. How to do?
*The results of the current study show that high-density lipoprotein and high-density lipoprotein cholesterol are not the same thing. What really needs to be elevated is high-density lipoprotein, It’s the lipoprotein part in it, not the HDL cholesterol.
* Drugs that increase high-density lipoprotein cholesterol have been studied, but they have not been used clinically because of obvious adverse reactions.
* Back to the first point, because elevated HDL cholesterol is still inconclusive, there is no practical test to prove that raising “high density” is beneficial, and also There is no specific drug to increase high-density lipoprotein cholesterol, so now, lowering of high-density lipoprotein cholesterol is not the target of blood lipid treatment, and there is nothing to do if high-density lipoprotein cholesterol is low. Cholesterol-lowering statins and triglyceride-lowering fenofibrate also partially increase high-density lipoprotein cholesterol.
So don’t worry about low HDL cholesterol.
Fourth thing. What to do with high lipoprotein a?
There is lipoprotein a in the complete blood lipid test. After publicity, everyone knows that lipoprotein a is not good, but what should I do if it is too high?
There are also 3 points:
*The increase of lipoprotein a is mainly related to genetic factors, and some diseases can affect lipoprotein a, and the genetic factors are not easy to solve at present;
* Some lipoprotein a lowering drugs are still being developed and undergoing clinical trials. There is no specific lipoprotein a lowering drug on the market. What can be done is plasma exchange, lipoprotein blood purification, and diafiltration of lipoprotein a.
*Elevated lipoprotein a causes atherosclerosis, or it is related to the increase of low-density lipoprotein cholesterol. Therefore, such patients can prevent atherosclerosis, Let’s lower “Low Density” again. Statins and blood lipid-lowering injections can reduce “low density”, and the latter can also reduce lipoprotein a.
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