Blood lipids are the worst evil? What are the drugs for treating hyperlipidemia?

Author: Chen Hong, Chief Physician, Peking University People's Hospital

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

Now when we talk about blood lipids, we think it is an unforgivable evil. Is it really so?

1. What exactly is blood lipid?

In fact, blood lipids are a normal component in the human body.

Professionally speaking, blood lipids are the general term for neutral fats and lipids in the human body. Simply put, blood lipids contain at least two things, one is cholesterol and the other is triglycerides.

In clinical practice, patients often think that blood lipids refer to only one thing. In fact, it includes many types, including at least cholesterol and triglycerides.

The sources of these two substances are different. Triglycerides in the human body are mainly ingested, while cholesterol is mainly synthesized by the human body in the liver. Therefore, if triglycerides are high, the effect of controlling diet will be very good, but if cholesterol is high, the effect of controlling diet will be very limited.

Figure 1 Original copyright image, no permission to reprint

They play very important physiological roles in the human body. Simply put, without these two substances, humans cannot survive.

The reason we can talk and move is because we have energy in our bodies, and one of the main sources of energy is triglycerides;

In addition, cholesterol also has extremely important physiological functions, such as synthesizing cell membranes. It is also the raw material for synthesizing bile acid. It is also an important raw material for synthesizing a series of our products, including growth hormone, sex hormone, and vitamin D.

Therefore, both triglycerides and cholesterol have very important physiological effects on our human body, so if they are too high, it will be harmful, but if they are too low, it will not be good either.

2. What types of hyperlipidemia are there?

Hyperlipidemia mainly refers to cholesterol levels exceeding 200mg/dl, or low-density lipoprotein cholesterol exceeding 160mg/dl, or triglycerides exceeding 150mg/dl. If any of these three indicators increases, it is called hyperlipidemia. According to the increase of different indicators, in medicine, we usually divide it into four categories:

The first type is called hypercholesterolemia, where only cholesterol is elevated;

The second type is hypertriglyceridemia, where only triglycerides are elevated;

The third type is hypoHDL, where only HDL cholesterol is reduced;

The fourth type is a combination of all three conditions, which we call mixed hyperlipidemia, and it mainly includes these four types.

Whether treatment is needed cannot be decided simply based on the levels of these indicators.

For example, if the low-density lipoprotein is greater than 160mg/dl, we consider it to be hyperlipidemia. However, for example, if a male hypertensive patient smokes, although his low-density lipoprotein cholesterol is only 150mg/dl, which is within the normal range, he has other high-risk factors and is already at high risk of cardiovascular disease, and needs to start treatment immediately.

Therefore, some patients believe that they do not need to take medicine as long as their blood lipids are within normal ranges. This is a common misunderstanding.

3. What should you pay attention to before having blood drawn to check blood lipids?

In the world today, there are two types of blood tests for lipid profiles: one is fasting, and the other is whether you are eating or not, but the most widely used is fasting. That is, you should not eat for 12 hours before blood draw. You can choose to have blood drawn in the morning and have breakfast after the blood draw.

In addition, you need to sit still for at least 5 minutes before having your blood drawn. These two are the most important conditions.

In addition, it is best to avoid eating too much meat and fish within 24 hours before blood collection, that is, avoid high-fat diets and try to maintain a relatively stable diet.

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Some friends may ask, can an abnormal test result directly confirm hyperlipidemia? Generally speaking, it is still hoped to have a re-examination, especially for hypertriglyceridemia. It is best to draw blood after fasting for 12 hours, because it is greatly affected by diet. Eating high-fat food 24 hours ago may affect the test results.

So generally speaking, we hope to have a recheck. If the blood sugar level is high this time, we will check again in half a month or a month. During this period, we will maintain a normal diet and then decide whether treatment is needed next.

4. What are the drugs for treating hyperlipidemia?

There are actually many drugs for treating hyperlipidemia, but those currently used in hospitals are mainly statins, PCSK9 inhibitors, fibrates, bile acid sequestrants, niacin and cholesterol inhibitors.

In the past, statins were mainly used to treat hypercholesterolemia. Statins are usually taken before going to bed at night. If statins cannot control hypercholesterolemia well, ezetimibe, a cholesterol absorption inhibitor, can be added. One tablet of ezetimibe per day is also acceptable. Bile acid sequestrants and niacin are less commonly used.

Of course, there are new drugs now, such as PCSK9 inhibitors, whose clinical generic name is evolocumab injection, which can also have good therapeutic effects.

In the past, the main drugs used for hypertriglyceridemia were fibrates, which are taken during the day. Of course, you can also choose high-purity medical fish oil preparations to lower triglycerides.

In short, there are many drugs for treating hyperlipidemia, and the specific one should be selected under the guidance of a doctor.