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Let’s talk about high blood lipid

Author：Dr.Liu Haixia

Blood lipid usually refers to cholesterol, triglycerides and esters in plasma, such as phospholipids. Blood lipid is an essential nutrient for human body and participates in body metabolism. With the change of modern lifestyle, a lot of people have increased blood lipids, also called hyperlipidemia ,especially in the elderly people. Hyperlipidemia is much associated with lifestyle, high fat and high sugar diet, excessive alcohol consumption, obesity and so on. It is also associated with concomitant disease or drugs, such as diabetes, kidney disease syndrome, hypothyroidism, polycystic ovary syndrome, diuretics, glucocorticoids, etc. Hyperlipidemia may be congenital, basically caused by gene mutation, which have obvious hereditary tendency and be called familial high lipidemia disease in clinical practice.

Total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL - C) and high-density lipoprotein cholesterol (HDL - C) are the main items for blood lipids testing in clinical practice. LDL - C is considered to be the main risk factor of atherosclerosis, and is also the key target index in the monitoring and management of hyperlipidemia. Elevated TG may lead to acute pancreatitis, even severe acute pancreatitis which may be life-threatening. HDL – C can transite cholesterol from extrahepatic tissues to the liver for metabolism and extracted from the body by bile. It has an anti-atherosclerosis effect and is beneficial to the body, so people also call it good cholesterol.

How to judge the blood lipids normal or abnormal? On what circumstances do they need to be treated? In fact it is usually up to the personal situation. For people with atherosclerosis, cardiovascular disease, diabetes, chronic kidney disease, LDL – C must be strictly controlled and lowered to the target level according to the relevant guidelines recommended. The target level for LDL-C control is different according to the different risk in cardiovascular disease.

Diet and lifestyle have great influence on blood lipids. Diet adjustment and lifestyle improvement are the basic measures to treat hyperlipidemia. Some patients with hyperlipidemia can reach the desired target through diet and non-drug therapy. These people also need regular review of blood lipids. Generally, after 3 to 6 months of diet and non-drug therapy, the blood lipids level should be reviewed. If the target can be reach, this method can be continued. The blood lipid level should be reviewed every 6 -12 months. 

When patients cannot improve their lifestyle or remove other secondary causes to get their blood lipids down to the desired level, they need to start medication. A variety of cholesterol-lowering drugs are used in clinic. Statins(eg, Atorvastatin, Rosuvastatin )are the main lipid-lowering drugs usually as the first choice if there is no contraindication. Patients with obvious elevated TG may given fibrates (e.g. Fenofibrate) for therapy. LDL - C absorption inhibitors (e.g. Ezetimibe) usually be combining used with statin if LDL – C is not reach the required target. For people with homozygous familial hypercholesterolemia, PCSK9 monoclonal antibody (Eluizumab injection) is recommended. Hypocol is lipid-regulating traditional Chinese medicine with similar effects to statins. They are refined by adding red koji into rice by biological fermentation, and have the effect of comprehensive regulation of blood lipids.

It is recommended to review the lipid level periodically after the start of cholesterol-lowering therapy . The drugs may have some side effects on people. the main side effects caused by statins are abnormal liver function, myopathy (myalgia, myositis and rhabdomyolysis), especially in the application with large doses. So it is recommended to review blood lipids, transaminase and creatine kinase after 4 - 8 weeks after the start of statin therapy. If there is no adverse reactions, and the lipids can reach the required target level , then review them in 3-6 months ,and then review once every  6-12 months . If the required target fails to reach after 3-6 months medication, it is necessary to adjust the drug doses or change into another statin or combine with another kind of lipid-lowering medicine, eg,  Ezetimibe. It is also required to have a review in 4-8 weeks after the drug adjustment, and once the target value is reached, the review interphase is extended longer from 3-6 months to 6-12 months. 

It is very important to maintain a long period of lifestyle improvement and lipid-lowering medication to obtain ideal clinical benefits.