Several common questions about hyperlipidemia.❓❓❓

Hyperlipidemia can be the result of a single genetic defect in lipoprotein metabolism. Or more commonly, it is the result of a combination of genes and lifestyle habits. This article will answer some common questions about hyperlipidemia. For example, how much does blood lipids need to be treated? Do you have to take hypolipidemic agents? What should you do if you have high triglycerides and cholesterol?

1. What's on the blood lipid test?

Blood lipids refer to the lipids in the blood circulation of the human body. Common blood lipid test include four basic items: total cholesterol, triglycerides, low-density lipoprotein cholesterol ("Bad" cholesterol, lower values ​​are better), and high-density Lipoprotein cholesterol ("Good" cholesterol, higher numbers are better). What we call hyperlipidemia is actually a kind of dyslipidemia, which can be an increase in one or more blood lipid components. For example, hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia (both of the above), high and low density lipoproteinemia. It can also be a decrease in a certain component, such as hypo-high-density lipoproteinemia. Generally speaking, doctors pay more attention to the level of low-density lipoprotein cholesterol. It is because this indicator is more closely related to cardio-cerebrovascular events such as myocardial infarction and cerebral infarction. Severe hypertriglyceridemia is associated with an increased risk of pancreatitis. Some tests will also have non-high-density lipoprotein cholesterol, apolipoprotein B, apolipoprotein A1, lipoprotein, etc. These indicators are also related to the risk of cardiovascular disease.

2. If the test does not exceed the standard, does it mean that the blood lipids are normal?

This may also be dyslipidemia. According to the disease and risk factors of each person, the standard value of blood lipids is also different. For example, the target values of low-density lipoprotein cholesterol for different groups of people are as follows:

• Diabetic patients over 40 years old: < 2.6mmol/L.
• Hypertension patients who smoke at 45 years old (male) and 55 years old (female): < 2.6mmol/L.
• People who smoke and are obese (weight/height square ≥28): < 2.6mmol/L.
• Patients with stable coronary heart disease, acute coronary syndrome, stroke, transient ischemic attack, and peripheral atherosclerosis: < 1.8mmol/L.

Most blood lipid tests do not give different standard values for different groups of people. Low-density lipoprotein cholesterol < 3.4mmol/L is the normal value, and blood lipids are often abnormal at this time. Therefore, even if the blood lipid test shows normal. You also need to follow up, and the doctor will determine the blood lipids.

3. Cholesterol and triglycerides are both high, which one should be lowered first?

It is generally recommended that statins are the first choice based on the characteristics of dyslipidemia. If hypertriglyceridemia is combined, a combination of statins and fibrates can be used. Since the metabolic pathways of statins and fibrates are similar. They both have the potential to damage liver function and there is also the risk of myositis and myopathy. Therefore, a small dose is required when starting to use them together. Take fibrates in the morning and statins in the evening, and closely monitor muscle enzymes and liver function. If there are no adverse reactions, gradually increase the statin dose.

4. Is it possible to stop the medication if I am worried about the side effects of statins?

Statins are the basic drugs for lipid-lowering therapy. Most people tolerate statins well. The occurrence of adverse reactions is very low. The following are the risks of potential adverse reactions:

Long-term use of statins increases the risk of new diabetes, with an incidence of about 10% to 12%. But because the benefits of statins for cardiovascular disease far outweigh the risk of new-onset diabetes. Therefore, regardless of whether you have diabetes or not, as long as you need lipid-lowering treatment, you must insist on taking statins.

• Long-term use of statins increases the risk of new diabetes, with an incidence of about 10% to 12%. But because the benefits of statins for cardiovascular disease far outweigh the risk of new-onset diabetes. Therefore, regardless of whether you have diabetes or not, as long as you need lipid-lowering treatment, you must insist on taking statins.
• The incidence of abnormal liver function is about 0.5% to 3.0%. More common in patients receiving high-dose statin therapy. If serum alanine aminotransferase (ALT) and (or) aspartate aminotransferase (AST) does not increase more than 3 times, it can be observed on the basis of the original dose or reduced dose. Some patients with transaminase can recover on their own normal.
• Cognitive dysfunction, also known as memory loss, is generally transient and can recover on its own.

5. If the blood lipid level is still up to standard after taking statin, can I double the dose?

Doubling the dose of statins can only further reduce low-density lipoprotein cholesterol by 6%, while the risk of adverse reactions is greatly increased. Therefore, it is not recommended to increase the dose of statins. The combined application of cholesterol absorption inhibitors such as ezetimibe can be used to further reduce the level of low-density lipoprotein cholesterol.

6. Do statins need to be taken at night?

Since the liver synthesizes more cholesterol at night, the reduction in low-density lipoprotein cholesterol can be slightly increased when statins are taken at night. However, atorvastatin, rosuvastatin and fluvastatin sustained-release tablets can be taken once a day at any time of the day due to the longer action time.

7. Can I eat grapefruit while taking statins?

Atorvastatin, simvastatin and lovastatin need to be metabolized in the body through a pathway called hepatic cytochrome P450 enzyme (CYP) 3A4. Grapefruit may inhibit the metabolic clearance of drugs, thereby increasing the concentration of statins in blood pressure and increasing the risk of serious side effects. Therefore, you should avoid grapefruit or grapefruit juice when taking the above statins. In addition, citrus fruits such as oranges and tangerines can also inhibit the metabolism of statins to a certain extent. For high-risk populations (such as the elderly, patients with reduced liver and kidney function, thin body, and more types of medications), it is also necessary to control the amount of those fruits. In addition to fruits, many drugs metabolized by CYP may also affect the blood concentration of statins. You should consult your doctor before taking the drug.

8. Is fish oil useful?

The main component of high-purity fish oil is omega-3 fatty acids, which are mainly used to treat hypertriglyceridemia. Studies have shown that high-
dose high-purity fish oil (4 g/day) can significantly reduce triglycerides and reduce the occurrence of adverse cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD). However, studies have used large doses of fish oil. It is difficult for the health products on the general market to achieve such a high dose. Small doses of fish oil may not be effective. Moreover, studies have shown that high-dose fish oil may increase the risk of atrial fibrillation, limiting its application.

9. How often do I need to check after receiving lipid-lowering treatment?

Patients who are taking lipid-lowering drugs for the first time and adjusting the type or dosage of lipid-lowering drugs: recheck blood lipids, transaminase and creatine kinase within 6 weeks of taking the drug.

Patients whose blood lipids can reach the target value and have no adverse drug reactions: gradually change to a review every 6 to 12 months.

Patients whose blood lipids are not up to standard and have no adverse drug reactions: monitor once every 3 months.

10. After taking a statin, blood lipids are normal, can the drug be stopped?

The answer is no. If there are no contraindications or adverse reactions, statins should be taken for a long time. To reduce the level of "bad" cholesterol and avoid further progress of atherosclerosis.