How to lower high cholesterol? Understand the risk level, take targeted measures, and help restore blood lipids to normal

Relevant data show that cardiovascular and cerebrovascular diseases are becoming more and more common among young people, and many people born in the 1990s have joined the "army of cardiovascular disease." Among the factors that induce cardiovascular and cerebrovascular diseases, "excessive" cholesterol data is the main driver, causing 77% of coronary heart disease mortality in my country [1]. However, one thing everyone needs to understand is that cholesterol can be good or bad, and low-density lipoprotein cholesterol (LDL-C) is "bad cholesterol" and is the "killer" that induces various cardiovascular and cerebrovascular diseases. So what is the normal good cholesterol data? How to lower high cholesterol? Let's answer them one by one below.

How to lower high cholesterol? First, understand the difference between good and bad cholesterol and its risk stratification

For some people with lower risk, the normal cholesterol indicators are as follows:

Total cholesterol (TC) [2]: It is the main culprit that causes elevated blood lipids. Its normal range should be 0-5.2mmol/L;

High-density lipoprotein cholesterol (HDL-C) [3]: Also known as "good cholesterol", it is like a silent "Cinderella" that actively removes excess cholesterol deposited in blood vessels, thereby reducing the risk of cardiovascular diseases such as heart disease. Its normal range should be 1.16-2.42mmol/L;

Low-density lipoprotein cholesterol (LDL-C) [4]: ​​Also known as “bad cholesterol”, it is like the “villain” in a story. It moves and lies wherever it goes in the blood vessels, forming atherosclerotic plaques. If it suddenly breaks off or ruptures one day, it will become a blood clot that blocks the blood vessels, causing cardiovascular and cerebrovascular diseases such as coronary heart disease and stroke. Its normal range should be 0-3.4mmol/l.

LDL-C is a pathogenic risk factor for cardiovascular and cerebrovascular diseases [5]. Meta-analysis shows that for every 1 mmol/L reduction in LDL-C, atherosclerotic cardiovascular disease (ASCVD) events are reduced by 20% to 23%. Therefore, the primary goal of lipid-lowering therapy is to lower LDL-C. The guidelines divide patients into five risk levels based on LDL-C indicators, existing disease states, and the number and level of other ASCVD risk factors, in order to achieve individualized and precise lipid-lowering therapy and improve the prevention and treatment of cardiovascular and cerebrovascular diseases [6].

Low-risk group & medium-risk group: This group of people has not experienced any ASCVD events, has no other medical history or risk factors, and only has slight abnormalities in blood lipids.

The lipid-lowering target for this group of people should be <3.4mmol/l.

High-risk group: This group of people has not experienced ASCVD events, but if they have severe dyslipidemia, such as LDL-C ≥ 4.9 mmol/L or TC ≥ 7.2 mmol/L, or are ≥ 40 years old and have diabetes, chronic kidney disease (CKD) stage 3-4, etc., as long as they meet any of the above conditions, they can be included in the high-risk group;

The lipid-lowering target for this group of people should be <2.6mmol/l.

Ultra-high-risk population: patients who have experienced ≥2 severe ASCVD events, such as myocardial infarction, cerebral infarction, etc.; or patients who have experienced 1 severe ASCVD event and have ≥2 high-risk factors;

The lipid-lowering target for this group of people should be <1.4mmol/l.

Extremely high-risk group: usually refers to other ASCVD patients who do not meet the ultra-high-risk criteria.

The lipid-lowering target for this group of people should be <1.8mmol/l.

How to lower high cholesterol? People at low and medium risk should intervene in their lifestyle in a timely manner

Lipid-lowering treatment includes lifestyle intervention and drug therapy. For low- and medium-risk groups, the first recommendation is a healthy lifestyle, including: a healthy diet, moderate physical activity, weight control, smoking cessation, and alcohol restriction.

Among them, a reasonable diet has a greater impact on blood lipids. Special attention should be paid to the following four points[7][8][9][10]:

1. Limit the total amount of fat intake to 20-25 g/d. Appropriately use unsaturated fatty acids, such as vegetable oils, to replace saturated fatty acids, such as animal oils, palm oil, etc.;

2. Avoid consuming trans fatty acids, such as hydrogenated vegetable oils;

3. Increase the intake of vegetables and fruits, whole grains, dietary fiber and fish;

4. Studies have found that Chinese people are more sensitive to dietary cholesterol, that is, for every 100 mg increase in cholesterol intake, Chinese people's blood cholesterol rises more. In particular, people at medium or higher risk of atherosclerotic cardiovascular disease (ASCVD) or patients with hypercholesterolemia should consider controlling their dietary cholesterol intake to less than 300 mg per day. Animal brains, livers, kidneys, lungs, caviar, and butter, which have particularly high cholesterol content, are not recommended for frequent consumption even if blood cholesterol is normal.

The "red and black list" of high cholesterol diets is as follows:

How to lower high cholesterol? If blood lipid levels are not up to standard, take lipid-lowering medication in time

If the blood lipid levels of low- and medium-risk people are still not up to standard after three months of lifestyle intervention, they need to follow the doctor's advice to start drug treatment. For patients with high cholesterol and above, their target organs or cardiovascular and cerebrovascular systems are already "injured", and failure to lower cholesterol is likely to further increase the risk of cardiovascular and cerebrovascular diseases. In this regard, the guidelines recommend that on the basis of lifestyle intervention, people at high risk or above can consider directly choosing moderate-intensity statins to start drug treatment [3].

As an all-around player among statin lipid-lowering drugs, Lipitor Atorvastatin Calcium Tablets are widely chosen by frontline doctors and patients. As the statin with the largest LDL-C lowering range within the approved dosage range in my country, 10-80 mg of Atorvastatin Calcium Tablets can reduce lipids by 37%-55%[11]. With consistent use, LDL-C can be easily kept within the treatment target range. At the same time, it can also reduce the risk of atherosclerotic cardiovascular diseases such as coronary heart disease, myocardial infarction, and cerebral infarction[4], and reduce the risk of total vascular events by 32%[12]. If taken for 3-5 years, the risk is reduced by 33%, and if taken for more than 6 years, the risk is reduced by 36%.

In addition, lipid-lowering treatment is a long-term process, and the safety of the drug is of vital importance. As an original drug, Lipitor Atorvastatin Calcium Tablets have more than 20 years of real clinical practice experience, accumulated more than 400 research data and annual application experience from 330 million patients worldwide, and their safety has been comprehensively tested [13]. These trials and clinical applications have shown that the probability of adverse reactions to Lipitor Atorvastatin Calcium Tablets is very small, and the applicable population is relatively wide. Even for patients with abnormal renal function, long-term use will not increase the burden on the kidneys, and high doses will not increase the risk of myalgia. In addition, as a long-acting lipid-lowering drug, Lipitor Atorvastatin Calcium Tablets are not restricted or affected by time or eating, and are more flexible to take, making them a reliable choice for long-term control of blood lipids.

Finally, the packaging of Lipitor Atorvastatin Calcium Tablets has been updated, and the Pfizer logo has become Viatris. This is because the company to which the product belongs has completed the official name change and the packaging has been updated accordingly. But don't worry, this is still the original drug. Although the packaging has changed, the quality, raw materials and production process of the drug have not changed, and the effect and safety of the drug remain the same. Therefore, you can rest assured to buy and use it, it is still the Lipitor we are familiar with.

In summary, how to lower high cholesterol? Through the above, everyone can first understand the difference between good and bad cholesterol, determine their own risk level based on the relevant cholesterol "cross-border" data, and then conduct corresponding lifestyle interventions or precise lipid-lowering treatments. Especially for low- and medium-risk groups, if their blood lipid levels are still not up to standard after a period of lifestyle intervention, they must follow the doctor's advice for lipid-lowering drug treatment. Long-term use of medium-strength statins such as Lipitor Atorvastatin Calcium Tablets can better lower blood lipids, stabilize plaques, and protect cardiovascular and cerebrovascular health, thereby significantly reducing the possibility of serious cardiovascular and cerebrovascular events.

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[8] Ginsberg HN, Karmally W, Siddigui M, et al. A dose-response study of the effects of dietarycholesterol on fasting and postprandial lipid and lipoprotein metabolism in healthy young men[]]Arterioscler Thromb, 1994,14(4):576-586. DOI: 10.1161/01.atv.14.4.576.

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[10] Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturatedfat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials[]]. PLos Med, 2010, 7(3):e1000252.DOI: 10.1371/journal.pmed.1000252.

[11] MR Law, et al. BMJ . 2003;326(7404):1423

[12] Szarek M, et al. J Am Coll Cardiol. 2020 May 5;75(17):2110-2118.

[13] Atorvastatin Original Drug® Product Instructions. August 22, 2023 edition.