The 8th National Disability Prevention Day | Strengthen disability prevention and do a good job in blood lipid monitoring and management

August 25, 2024 is the eighth National Disability Prevention Day. This year's publicity theme is "Preventing disease and disability and sharing a healthy life."

The number of people suffering from cardiovascular diseases in my country has been increasing year by year. The "China Cardiovascular Health and Disease Report (2021)" estimates that the number of cardiovascular disease patients in my country has reached 330 million, including 11.39 million with coronary heart disease and 13 million with stroke. At present, cardiovascular disease deaths rank first among the total causes of death among urban and rural residents, 46.74% in rural areas and 44.26% in cities. Two out of every five deaths are caused by cardiovascular disease. Cardiovascular and cerebrovascular diseases are characterized by high prevalence, high disability rate, high recurrence rate and high mortality rate. Hypertension, diabetes, dyslipidemia, overweight/obesity, smoking, etc. are the main and modifiable risk factors for cardiovascular disease.

Among them, the monitoring and management of blood lipids often receive little attention.

So, what is dyslipidemia? What should we pay attention to when testing blood lipids? And how can we stabilize blood lipids? ?

01 Definition and origin of blood lipids

Blood lipids refer to the general term for cholesterol, triglycerides and lipids (such as phospholipids) in the blood.

There are two main sources of blood lipids: one is exogenous, that is, it enters the blood through digestion and absorption of food; the other is endogenous, which is synthesized by the liver, fat cells and other tissues and then released into the blood.

02 What is dyslipidemia?

Dyslipidemia refers to abnormalities in various blood lipid components, including elevated levels of cholesterol and/or triglycerides in the blood (commonly known as hyperlipidemia) and decreased high-density lipoprotein cholesterol.

The appropriate and abnormal blood lipid levels of adults in my country are mainly divided into the following five standards:

● Ideal level : LDL cholesterol < 2.6, non-HDL cholesterol < 3.4

● Suitable level : total cholesterol < 5.2, low-density lipoprotein cholesterol < 3.4, triglycerides < 1.7, non-high-density lipoprotein cholesterol < 4.1

● Borderline elevated : total cholesterol ≥ 5.2 and < 6.2, LDL cholesterol ≥ 3.4 and < 4.1, triglycerides ≥ 1.7 and < 2.3, non-HDL cholesterol ≥ 4.1 and < 4.9

● Elevated : total cholesterol ≥ 6.2, LDL cholesterol ≥ 4.1, triglycerides ≥ 2.3, non-HDL cholesterol ≥ 4.9

● Lower : HDL cholesterol < 1.0

03 What are the precautions for blood lipid testing?

Recommended clinical lipid profiles include total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.

Total cholesterol refers to the sum of cholesterol contained in various lipoproteins in the blood. Low-density lipoprotein cholesterol is a pathogenic risk factor for atherosclerotic cardiovascular disease and the primary intervention target for lipid-lowering therapy.

Non-HDL cholesterol is obtained by subtracting LDL cholesterol from total cholesterol, representing the total amount of lipoprotein cholesterol containing apolipoprotein B. Non-HDL cholesterol can also be used as an intervention target for primary and secondary prevention of atherosclerotic cardiovascular disease.

Things to note when testing blood lipids :

(1) Maintain normal eating habits within 2 weeks before the test;

(2) No strenuous physical activity within 24 hours before the test;

(3) Fasting test, fasting for about 8-12 hours;

(4) Rest in your seat for at least 5 minutes before blood collection, and then sit down for blood collection.

04 How often should blood lipids be screened?

Blood lipid screening is beneficial for early detection of people with dyslipidemia and guiding risk assessment and intervention treatment of atherosclerotic cardiovascular disease.

(1) Healthy adults aged 20-40 should have their blood lipids measured every 2-5 years;

(2) People aged 40 years and above should have their blood lipids tested at least once a year;

(3) Patients with atherosclerotic cardiovascular disease and high-risk groups should have their blood lipids measured every 3-6 months;

(4) Patients hospitalized for atherosclerotic cardiovascular and cerebrovascular diseases should have their blood lipids tested upon admission or within 24 hours.

05 Who needs to focus on blood lipid screening?

▼ Those with a history of atherosclerotic cardiovascular disease;

▼ Those with multiple risk factors for atherosclerotic cardiovascular disease (such as hypertension, diabetes, obesity, smoking);

▼ Those with a family history of premature atherosclerotic cardiovascular disease (male first-degree relative <55 years old or female first-degree relative <65 years old with atherosclerotic cardiovascular disease) or familial hyperlipidemia;

▼ Those with skin or tendon xanthomas and thickening of the Achilles tendon.

06 Principles for the prevention and treatment of dyslipidemia, here we go!

Therapeutic lifestyle changes

Therapeutic lifestyle changes are the basic measures for the treatment of dyslipidemia , which include adjusting the diet structure, controlling weight, exercising, quitting smoking and limiting alcohol consumption. Regardless of whether or not lipid-lowering drug treatment is performed, therapeutic lifestyle changes must be adhered to.

Different intensity interventions

Taking intervention measures of different intensities according to the risk of atherosclerotic cardiovascular and cerebrovascular diseases is the core strategy for the prevention and treatment of dyslipidemia. In clinical practice, whether to initiate lipid-lowering drug treatment should be determined based on the individual's risk of atherosclerotic cardiovascular and cerebrovascular diseases.

Different standards for different groups of people

People at different risk levels need to achieve different LDL cholesterol targets:

● Diabetic patients aged 40 years and above: <2.6 mmol/L, or a decrease of ≥50%;

● High-risk individuals with LDL cholesterol <2.6 mmol/L, or a decrease of ≥50%;

● For medium-risk and low-risk individuals, LDL cholesterol is <3.4 mmol/L, or the reduction is ≥30%.

Drug treatment requires long-term adherence

Moderate-intensity statins are the first choice for drug treatment, and they should be used on a long-term basis. If the target cannot be achieved, combination therapy can be considered, and proprotein convertase subtilisin 9 inhibitors can be added if necessary.

Baseline liver and muscle enzyme testing

Before starting lipid-lowering drug treatment, baseline liver enzyme and muscle enzyme tests should be performed. For those who take lipid-lowering drugs for the first time, blood lipids, transaminases and creatine kinase should be rechecked within 6 weeks of taking the drugs.

If the blood lipids meet the standard and there are no adverse reactions, gradually change to re-examination every 6-12 months; if the blood lipids do not meet the standard and there are no adverse reactions, monitor once every 3 months.

If blood lipids still do not reach the target level after 3-6 months of treatment, the dose or type of lipid-lowering drugs should be adjusted, or lipid-lowering drugs with different mechanisms of action should be used in combination for treatment. Whenever the type or dose of lipid-lowering drugs is adjusted, a follow-up examination should be performed within 6 weeks of treatment.

Reference: "Guidelines for Blood Lipid Management in China (Grassroots Edition 2024)"