Lifestyle changes and drug treatment for dyslipidemia

This is the 3898th article of Da Yi Xiao Hu

It is well known that adjusting diet, losing weight, exercising appropriately and improving lifestyle habits are the basis for preventing and treating dyslipidemia, but the specific operations for different types of dyslipidemia are also very particular.

Lifestyle Improvement

Improve your eating habits

For different types of dyslipidemia, the following dietary improvements are recommended

1. For high total cholesterol and low-density lipoprotein cholesterol

You can limit the cholesterol content in food, preferably below 300 mg per day;

Eat less or no animal offal, brains, egg yolks, caviar, shrimp paste, and scaleless fish such as crabs and squids;

Eat more foods containing plant sterols, such as soybeans and their products, followed by green beans. Plant sterols can inhibit the absorption of cholesterol, thereby lowering the level of total cholesterol.

2. For simple low HDL cholesterol

You can appropriately supplement foods rich in omega-3, such as deep-sea fish, etc.; increase foods rich in water-soluble fiber, mainly fruits and vegetables;

Avoid trans fats and consume less saturated fats, such as animal fats, palm oil, etc.

Also quit smoking and increase aerobic exercise.

3. Simply high triglycerides

The total fat intake, including cooking oil, should be strictly controlled and should not exceed 50 grams per day.

Vegetable oils such as olive oil, rapeseed oil, and coconut oil in moderation can help lower blood lipids. Do not eat animal fat, animal fat, or butter;

Eat fruits in moderation, no more than 200 grams per day, as too much fructose will also be converted into triglycerides;

Eat nuts in moderation, no more than 25 grams per day;

Protein foods are mainly soy products, skinless poultry, fish, lean meat, and eggs. You can appropriately supplement with foods rich in omega-3.

It is best to choose low-fat or skimmed dairy products

Increase dietary fiber intake, such as eating more whole grains, whole grains, and vegetables;

In terms of cooking methods, steaming, stewing, boiling and braising should be the main methods. Eat less fried foods, and quit smoking and drinking.

Lose weight

Obesity is bound to have an adverse effect on blood lipids, and we should control our body mass index (BMI) to around 22. BMI = weight (kg) / height (m) squared.

Proper exercise

It is recommended to do moderate intensity aerobic exercise for 30 minutes 5-7 days a week. What is moderate intensity? It means that when you can maintain a normal conversation speed while exercising, but you cannot sing. This is moderate intensity aerobic exercise. Exercise can be done in the form of moderate speed walking, jogging, swimming, etc. However, patients with cardiovascular and cerebrovascular diseases should do it within their ability, and those with severe conditions should do it under the guidance of a doctor.

Correcting unhealthy lifestyle

Such as quitting smoking, limiting alcohol and salt intake, not sitting for long periods of time, going to bed early and getting up early, and not staying up late.

Drugs for the treatment of dyslipidemia

On the basis of the above-mentioned improvement measures, if the blood lipid level shows obvious recovery or even returns to normal levels within one month, then you can stick to this healthy lifestyle and pay attention to monitoring and regular check-ups; if there is no obvious improvement in blood lipid levels after one month, drug treatment may be necessary.

Due to large individual differences, there is no absolutely best, fastest, and most effective medication. In addition to commonly used over-the-counter drugs, you should choose the most appropriate medication under the guidance of a doctor and fully consider your personal circumstances.

The lipid-lowering drugs currently used in clinical practice mainly include statins, cholesterol absorption inhibitors, PCSK9 inhibitors, bile acid chelators, n-3 fatty acids, and fibrates. Fibrates are mainly used for hypertriglyceridemia. Except for severe hypertriglyceridemia, statins are generally the first choice for drug treatment of dyslipidemia. The above lipid-lowering drugs have good overall safety, but changes in blood ALT, AST, and creatine kinase should be detected during medication. Lipid-lowering drugs are contraindicated for pregnant and lactating women.

HMG-CoA reductase inhibitors (statins)

Commonly used drugs include lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, rosuvastatin, etc. They mainly reduce serum TC and LDL-C, and also reduce TG to a certain extent, and slightly increase HDL-C levels.

Phenoxyaromatic acids (fibrates)

Commonly used drugs include fenofibrate, bezafibrate, etc. They mainly reduce serum TG, and can also reduce TC and LDL-C to a certain extent, and increase HDL-C.

Niacin

It belongs to the B vitamins, can inhibit lipolysis of adipose tissue and reduce cholesterol synthesis and secretion. It is also suitable for hypertriglyceridemia and mixed hyperlipidemia with elevated triglycerides as the main feature. It is contraindicated in chronic liver disease and severe gout, and should be used with caution in hyperuricemia and peptic ulcer.

Bile acid sequestrants (resins)

Drugs include cholestyramine, colestipol, etc. However, they are rarely used clinically due to their many side effects.

Intestinal cholesterol absorption inhibitors

The main drug is ezetimibe, which is mainly used in combination with statins.

Probucol

It can affect lipoprotein metabolism, produce lipid-regulating effects, and reduce TC, LDL-C, and HDL-C. It is suitable for people with hypercholesterolemia, especially homozygous familial hypercholesterolemia. However, this drug can often cause nausea symptoms, and in severe cases, arrhythmias.

Omega-3 fatty acid preparations

High concentrations of omega-3 fatty acids, especially EPA, have the effect of lowering triglycerides

PCSK-9 inhibitors

Proprotein convertase/subtilisin/kexin type 9 inhibitors (PCSK-9 inhibitors) are a new type of lipid-lowering drug. Existing studies have shown that on the basis of the use of statins, PCSK-9 inhibitors can significantly reduce the concentration of low-density lipoprotein cholesterol (LDL-C) in the human body, and reduce the risk of a series of adverse cardiovascular events including coronary revascularization by inducing plaque regression, thereby improving patients' cardiovascular outcomes. However, due to its subcutaneous injection method and the previous high cost of treatment, the target population is limited. At present, PCSK-9 inhibitors have been included in the medical insurance coverage, which greatly reduces the medication burden of patients and is a boon for patients with dyslipidemia and cardiovascular and cerebrovascular diseases.

Here we need to remind everyone that the specific medications to be used and how to use them should be carried out under the guidance of professional doctors and pharmacists. Do not take medications privately. If there are any adverse reactions during medication, such as stomach pain, diarrhea, muscle aches, etc., please consult a doctor in time. In addition, relevant indicators should be tested regularly according to the doctor's instructions to reduce the occurrence of adverse reactions and possible consequences.

Author: Department of Pharmacy, Shanghai Sixth People's Hospital

Zhao Yun, Chief Pharmacist