What Is Hyperlipidemia?

Hyperlipidemia refers to high blood lipid levels, which can directly cause some diseases that seriously endanger human health, such as atherosclerosis, coronary heart disease, and pancreatitis.

Basic Information

nickname: Lipidemia
English name: hyperlipoidemia

Visiting department: Endocrinology
Common causes: Related to genetics, diet, nutrition, drugs and other factors
Common symptoms: Yellow tumor, dizziness and discomfort

Causes of hyperlipidemia

Hyperlipidemia can be divided into two categories: primary and secondary. Primarily related to congenital and genetic, is due to a single gene defect or multiple gene defects, abnormal receptors, enzymes or apolipoproteins involved in lipoprotein transport and metabolism, or due to environmental factors (diet, nutrition, drugs ) And through unknown mechanisms. Secondary diseases often occur in metabolic disorders (diabetes, hypertension, myxedema, hypothyroidism, obesity, liver and kidney disease, hyperadrenal function), or with other factors such as age, gender, season, drinking, smoking, smoking, Diet, physical activity, mental stress, emotional activity, etc.

Clinical manifestations of hyperlipidemia

The clinical manifestations of hyperlipidemia are mainly xanthomas caused by lipid deposition in the dermis and arteriosclerosis caused by lipid deposition on vascular endothelium. Although hyperlipidemia can cause xanthomas, its incidence is not high; and the occurrence and development of atherosclerosis is a slow and gradual process. Therefore, under normal circumstances, most patients have no obvious symptoms and abnormal signs. Many people find elevated plasma lipoprotein levels when performing blood biochemical tests for other reasons.

Hyperlipidemia test

1. Determination of lipid profile

Fasting TC, TG, LDL-C, HDL-C.

2. Judge the presence or absence of chylomicrons in the plasma

A simple method is to put the plasma in a refrigerator at 4 ° C overnight, and then observe whether the plasma has a "creamy" top layer.

3. Plasma low density lipoprotein (LDL-C) concentration

Within 1 to 2 weeks, there can be ± 10% variation in plasma cholesterol levels, and laboratory variation is allowed within 3%.

4. Special examinations on lipid metabolism

(1) Apolipoprotein determination Determination of plasma ApoB and ApoA levels is of great significance in predicting the risk of coronary heart disease.

(2) Lipoprotein metabolism test in vivo In addition, gene DNA mutation analysis, lipoprotein-receptor interaction, and determination of lipoprotein lipase and liver lipase, cholesterol lipase, and synthetase can be performed.

5. Other inspections

Familial mixed hyperlipidemia and familial hypertriglyceridemia have insulin resistance, their plasma insulin levels are elevated, and clinical manifestations of impaired glucose tolerance; type III hyperlipoproteinemia is often associated with diabetes; familial Mixed hyperlipidemia may be accompanied by hyperuricemia; patients with type III hyperlipoproteinemia may be accompanied by hypothyroidism.

Hyperlipidemia diagnosis

Regarding the diagnostic criteria of hyperlipidemia, there is currently no unified method at home and abroad. Previously, it was considered that total cholesterol concentration> 5.17 mmol / L (200 mg / dl) could be classified as hypercholesterolemia, and plasma triacylglycerol concentration> 2.3 mmol / L (200 mg / dl) was hypertriglyceridemia. Different regions have different diagnostic criteria for hyperlipidemia due to different test groups and different test methods. However, in order to prevent atherosclerosis and coronary heart disease, the appropriate plasma cholesterol level should be determined according to the risk of cardiovascular and cerebrovascular diseases in the future. The higher the risk, the lower the appropriate plasma cholesterol level.

The new standard recommends that drug therapy be started when the LDL-C concentration is> 130mg / dl, and the LDL-C concentration is <100mg / dl as the treatment target. If the risk of cardiovascular and cerebrovascular disease in the future is high, drug therapy should be started earlier Take stricter treatment goals. Low HDL-C concentration is a risk factor for coronary heart disease, <40mg / dl. The classification standard of triacylglycerol was lowered, and more attention was paid to moderate elevation.

Hyperlipidemia treatment

1. Control your ideal weight

Many epidemiological data show that average plasma cholesterol and triacylglycerol levels are significantly higher in obese people than in non-obese people of the same age. In addition to a significant positive correlation between body mass index (BMI) and blood lipid levels, the distribution of body fat is also closely related to plasma lipoprotein levels. Generally, people with central obesity are more likely to develop hyperlipidemia. After obese people lose weight, dyslipidemia can return to normal.

2. Exercise

Physical exercise can not only enhance cardiopulmonary function, improve insulin resistance and glucose tolerance, but also reduce weight, lower plasma triacylglycerol and cholesterol levels, and increase HDL cholesterol levels.

In order to achieve the purpose of safety and effectiveness, the following matters should be paid attention to when exercising:

(1) Exercise intensity The amount of exercise is usually measured by the level of heart rate after exercise. The appropriate exercise intensity is generally that the heart rate after exercise is controlled at about 80% of the individual's maximum heart rate. Aerobic activities such as medium-speed walking, jogging, swimming, skipping, doing aerobics, cycling, etc. are appropriate.

(2) Duration of exercise Before each exercise begins, preparatory activities should be carried out for 5 to 10 minutes, so that the heart rate gradually reaches the above level, and then maintained for 20 to 30 minutes. After exercise, it is best to relax for 5-10 minutes. At least 3 to 4 times a week.

(3) Pay attention to safety protection during exercise.

3. Quit smoking

Smoking increases plasma cholesterol and triacylglycerol levels and decreases HDL-cholesterol levels. After stopping smoking for 1 year, the plasma HDL-cholesterol level can rise to the level of non-smokers, and the risk of coronary heart disease can be reduced by 50%, even closer to non-smokers.

4. Diet therapy

Plasma lipids are mainly derived from food. By controlling the diet, plasma cholesterol levels can be reduced by 5% to 10%, and at the same time help to lose weight. And make the lipid-lowering drugs play the best effect. Most patients with type III hyperlipoproteinemia are treated with diet and at the same time correct other coexisting metabolic disorders, which can often reduce blood lipid levels to normal.

The timing of dietary treatment depends mainly on the risk of coronary heart disease and the plasma LDL-cholesterol level of the patient. In general, the higher the risk of coronary heart disease, the lower the plasma LDL-cholesterol level when starting diet therapy.

The diet treatment of hyperlipidemia is a method of controlling the diet, while maintaining the ideal weight, reducing the level of LDL-cholesterol in the plasma.

Diet structure can directly affect the level of blood lipids. Plasma cholesterol levels are susceptible to cholesterol intake in the diet. Eating large amounts of saturated fatty acids can also increase cholesterol synthesis. Generally, foods such as meat, eggs, and dairy products (especially egg yolks and animal viscera) contain a lot of cholesterol and saturated fatty acids. Edible oil should be mainly vegetable oil, and the daily dosage of each person is preferably 25-30g. Patients with familial hypercholesterolemia should strictly limit the intake of cholesterol and fatty acids in food.

5. Drug treatment

Statins and resins are mainly used to lower serum total cholesterol and LDL cholesterol. Drugs that mainly lower serum triacylglycerols include fibrates and nicotinic acids.

6. Non-drug treatment for severe dyslipidemia

Some patients with dyslipidemia can achieve ideal blood lipid regulation effects by adjusting diet and improving lifestyles. Very few patients have very high blood lipid levels, which are more common in patients with genetic abnormalities and can be treated by plasma purification and surgery. Gene therapy has the potential to overcome refractory hereditary dyslipidemia in the future.

Hyperlipidemia prognosis

People with dyslipidemia often have multiple cardiovascular risk factors. Blood lipid levels and decreases cause the incidence and mortality of cardiovascular disease to decrease with lower serum total cholesterol and LDL cholesterol levels.