Don't be "cheated" by the medical examination form! Your blood lipids are normal only if they are within this range

Doctor, my blood lipids are high, why don't you prescribe medicine for me? Doctor, my blood lipids are within the normal range, why do you prescribe medicine for me?

Emm, blood lipids cannot be determined simply by looking at the ↑↓ on the test report.

Today, let’s talk about whether you need to take medicine for dyslipidemia? What medicine should you take? What level should you control it to?

01

What is hyperlipidemia

Hyperlipidemia is a common disease, which is an abnormal metabolism of lipoproteins in the human body, mainly including increased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and/or decreased high-density lipoprotein cholesterol (HDL-C).

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02

Do you need to take lipid-lowering drugs?

Generally speaking, total cholesterol (TC) should not exceed 5.2mmol/L, low-density lipoprotein cholesterol (LDL-C) should not exceed 4.1mmol/L, and triglycerides (TG) should not exceed 1.7mmol/L.

If you are a healthy person and your blood lipids exceed the above values, you should pay attention to controlling your diet, increasing exercise, losing weight, limiting alcohol consumption, and taking medication under the guidance of a doctor if necessary.

If coronary heart disease, cerebrovascular disease and other diseases have already occurred, even if ↑ does not appear on the test report, even if it is ↓, medication should be used to control the low-density lipoprotein cholesterol (LDL-C) to 1.8mmol/L or even below 1.4mmol/L.

03

What is the lipid-lowering target?

The control target value of low-density lipoprotein cholesterol (LDL-C) is determined based on the patient's atherosclerotic cardiovascular disease (ASCVD, including coronary heart disease, stroke and peripheral vascular disease, commonly known as cardiovascular and cerebrovascular diseases) risk stratification.

Risk factors*: age (male ≥45 years, female ≥55 years), smoking, and low HDL-C.

In order to effectively reduce the risk of ASCVD, the target values ​​of low-density lipoprotein cholesterol (LDL-C) are different for different risk levels:

① Low-risk: LDL-C < 3.4mmol/L

② Moderate and high risk: LDL-C＜2.6mmol/L

③ Extremely high risk: LDL-C <1.8mmol/L and decreased by >50% compared with baseline

④ Ultra-high risk: LDL-C <1.4mmol/L and decreased by >50% compared with baseline

04

What are lipid-lowering drugs?

At present, the lipid-lowering drugs commonly used in clinical practice in China mainly include statins, fibrates, niacin and cholesterol absorption inhibitors.

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Most people with high cholesterol can use moderate-intensity statins (such as atorvastatin 10-20 mg/day). Those whose cholesterol levels cannot reach the target after treatment can add ezetimibe to statin treatment.

Fibrates and niacin are not recommended for pharmacological intervention of dyslipidemia unless triglycerides (TG) are severely elevated or statin therapy is intolerant.

05

Frequency of lipid screening

Blood lipid levels should be rechecked 3 to 6 months after lifestyle intervention. If blood lipid parameters such as low-density lipoprotein cholesterol (LDL-C) are up to standard, treatment should be continued, but rechecking is still required every 6 months to 1 year. If low-density lipoprotein cholesterol (LDL-C) continues to be below the target value, rechecking once a year is sufficient.

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Recheck blood lipids, liver function and creatine kinase 4 to 8 weeks after the start of drug treatment. If there are no special circumstances, gradually change to recheck every 6 to 12 months. If the low-density lipoprotein cholesterol (LDL-C) does not reach the target value after rechecking 3 to 6 months after the start of treatment, adjust the dose or type of drug, or combine drug treatment, and recheck after 4 to 8 weeks. After reaching the target value, extend the recheck to every 6 to 12 months.

06

Does dyslipidemia require long-term treatment?

Adherence to non-drug treatment is an important measure to correct hyperlipidemia. Even after starting drug treatment, you should continue to control your diet and exercise actively, and you should not relax your lifestyle intervention just because of drug treatment.

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Most people with hyperlipidemia, especially those who have developed atherosclerotic cardiovascular disease (ASCVD) and/or diabetes, need long-term medication.

Pay attention!

You cannot stop taking the medicine or reduce the dosage on your own just because your cholesterol level has dropped below the target value after a period of treatment. You must make adjustments under the guidance of a doctor, otherwise the risk of unexpected cardiovascular disease events will be significantly increased.

07

How to carry out lifestyle intervention

Controlling dietary cholesterol intake

Increase the intake of vegetables, fruits, and crude fiber foods, and limit alcohol consumption (alcohol intake for men <25g/day, for women <15g/day).

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Increase physical activity

Do moderate-intensity aerobic exercise for 30 to 60 minutes every day, at least 5 days a week. Maintain your ideal body weight. If you need to lose weight, you should continue to increase your weekly exercise time.

Control of other risk factors

For patients who smoke, quitting smoking can reduce the risk of cardiovascular disease and mortality.

References:

[1] Guidelines for the prevention and treatment of dyslipidemia in Chinese adults (2016 revised edition)

[2] China’s Guidelines for Blood Lipid Management (2023)

Source: Department of General Medicine, Run Run Shaw Hospital

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