What are the differences among blood lipid 2 items, blood lipid 4 items and blood lipid 7 items? How to choose?

Hyperlipidemia is an independent risk factor for cardiovascular and cerebrovascular diseases!
If long-term high blood lipids are not controlled, more "vascular garbage", namely plaques, will be produced, leading to vascular stenosis and ischemia. In the most serious cases, plaque rupture and thrombosis will occur, leading to myocardial infarction or cerebral infarction, causing disability or death!

When we go to the hospital to have blood drawn for tests to check our blood lipids, we often don't understand what blood lipids are, what blood rheology is, what cholesterol is, and what triglycerides are.
Many people are confused and often waste money, fail to get important indicators tested, or spend money but fail to get the key points tested, or even spend too much money to test some items that are not very important.

1. Are blood lipids and blood rheology the same?

I often see patients like this in the outpatient clinic: "Doctor, please prescribe a blood rheology test to see if my blood is thick."
In fact, cardiovascular doctors are not concerned about blood rheology or blood viscosity. We mainly look at whether the blood lipids are high.
But generally speaking, the blood rheology test is not a blood lipid test. Often, after paying for a blood rheology test, people ask the doctor, "Doctor, is my blood lipid high?"
The two looked at each other because there was no blood lipid test result on the test results.
On the blood rheology, the words whole blood viscosity (high shear), whole blood viscosity (low shear), whole blood viscosity (medium shear) are often written...
These data are actually different from blood lipids. These blood viscosity indicators are not stable and cannot accurately reflect our cardiovascular disease risk. Among the high-risk factors for cardiovascular disease, doctors are not recommended to draw blood from patients for tests on blood rheology or blood viscosity.
Blood viscosity is affected by many factors, such as emotional excitement, stress response, anxiety, smoking, hypoxia, chronic obstructive pulmonary disease, congenital heart disease, tumors, vomiting, diarrhea, sweating, burns, etc.
On the one hand, the guidelines do not recommend it, and on the other hand, the indicators are unstable, so we generally do not check blood rheology, we focus on blood lipids.

2. Blood lipids and cholesterol

What's Different About Triglycerides?

Many people are confused about the relationship between blood lipids, cholesterol and triglycerides, and often say: My triglycerides are high, but my blood lipids are not high; my cholesterol is high, but my blood lipids are not high; my cholesterol and triglycerides are normal, why didn’t I check my blood lipids?

In fact, cholesterol and triglycerides are blood lipids!

When we go to the hospital, we often have 2, 4, or 7 blood lipid tests. Apart from the large price differences among these tests, from a purely medical perspective, how many blood lipid tests should we have?

1. 2 blood lipid items:

Blood lipids are a general term for cholesterol and triglycerides; that is to say, both cholesterol and triglycerides are blood lipids. Elevated triglycerides are called hypertriglyceridemia; elevated cholesterol is called hypercholesterolemia; elevated cholesterol is called mixed hyperlipidemia; all three conditions are hyperlipidemia, which is what we call high blood lipids.

When cholesterol rises, the accumulation of lipid substances will increase, more vascular plaques will be produced, and the risk of cardiovascular and cerebrovascular diseases will increase.

Although elevated triglycerides will not directly lead to vascular plaques, they will indirectly increase the risk of cardiovascular and cerebrovascular diseases. At the same time, when triglycerides exceed 5.6mmol/L, the risk of acute pancreatitis will also increase.

Therefore, it is not a good thing when these two blood lipids are elevated. When you see that these two blood lipids are elevated, you have to find ways to lower them.
The basis for lowering blood lipids is to control diet. On the basis of a healthy diet, lipid-lowering drugs can be taken when necessary: ​​statins mainly lower cholesterol, and fibrates mainly lower triglycerides.
What we cardiovascular doctors are most concerned about is actually low-density lipoprotein cholesterol, which is the precursor of "vascular garbage." Once low-density lipoprotein cholesterol rises, we will aggravate and accelerate atherosclerosis, that is, vascular plaques.

However, there is no low-density lipoprotein cholesterol in the two blood lipid items. Therefore, in general tests, we will not simply prescribe two blood lipid items, but recommend testing four blood lipid items.

2. 4 blood lipid items:

The 4 blood lipid items are based on the 2 blood lipid items of cholesterol and triglycerides, plus: low-density lipoprotein cholesterol and high-density lipoprotein cholesterol.
High-density lipoprotein cholesterol is a good blood lipid, which can "clean up blood vessel garbage", that is, delay the progression of atherosclerosis. So when we see an increase in high-density lipoprotein, don't worry, because it is a good blood lipid, and the better it is, the better.
Low-density lipoprotein cholesterol is a bad blood lipid, and it can even be said to be the worst blood lipid, so cardiovascular doctors pay close attention to low-density lipoprotein cholesterol.
Low-density lipoprotein cholesterol is very interesting. Unlike other indicators, which have only one standard, low-density lipoprotein cholesterol has three standards:

The average person's low-density lipoprotein cholesterol is ≤3.4mmol/L, which means that for people who do not have any cardiovascular or cerebrovascular disease and do not have any high-risk factors, it is best to lower their low-density lipoprotein cholesterol to below 3.4mmmol/L.

High-risk people are ≤2.6mmol/L, that is, people with hypertension, diabetes, family history, obesity, or LDL cholesterol ≥4.9mmol/L. It is best for these people to lower their LDL cholesterol to below 2.6mmol/L.

For extremely high-risk people, the low-density lipoprotein cholesterol is ≤1.8mmol/L, that is, people with ischemic cardiovascular and cerebrovascular diseases such as coronary heart disease, myocardial infarction, heart stents, heart bypass surgery, angina pectoris, cerebral infarction, severe carotid artery plaques, etc. It is best for these people to reduce their low-density lipoprotein cholesterol to below 1.8mmol/L.

When we look at the blood lipid test report, we mainly look at the low-density lipoprotein cholesterol!

3: 7 blood lipids:

When some people get a test report, they often see several items of lipoprotein, which are the 7 items of blood lipids.

On the basis of the four blood lipids, lipoprotein apoA, lipoprotein B and lipoprotein a are added. So what do these lipoproteins mean? What is their significance? Are they good or bad?
When lipoprotein a increases, the risk of thrombosis increases. It is common in patients with coronary heart disease, acute myocardial infarction, diabetes, and familial hypercholesterolemia, and is a risk factor for cardiovascular and cerebrovascular diseases. Therefore, lipoprotein a is a bad blood lipid, and a lower level is better.
When lipoprotein B increases, the risk of cardiovascular and cerebrovascular diseases will also increase, so lipoprotein B is also a bad blood lipid, and it is better to keep it lower.
Lipoprotein apoA is involved in the transport of cholesterol, which is beneficial to the "cleaning" of "vascular garbage", so lipoprotein apoA is a good blood lipid and it doesn't matter if it is a little high.
Adding these three blood lipids to the four blood lipids has certain diagnostic or judgment significance. However, when we see patients in the clinic, we do not directly prescribe medication based on the increase or decrease of these three items.
According to the guidelines, we are still making diagnoses and treatment plans for patients, as well as whether to use medication and which medication to use, based on the four blood lipid items, namely total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.
Therefore, unless there are special circumstances, we generally test 4 blood lipid items instead of 2 or 7!