Hyperlipidemia, also known as hyperlipidemia or dyslipidemia, usually refers totriglycerideAnd (or)total cholesterolrise,Low density lipoprotein cholesterolRaise andHigh density lipoprotein cholesterolLower.The occurrence of this disease can be seen in people of different ages and genders, especially in people aged 50 to 69, with obvious genetic tendency.The causes of diseases include gene mutation, various environmental factors, such as bad eating habits, insufficient physical activity, obesity, and other diseases such asdiabetes、Nephrotic syndrome、Liver diseaseEtc.
Typical symptoms of hyperlipidemia includeXanthoma、Early-onset corneal ringThe fundus changes, but in most cases, the symptoms are not obvious, and they are usually found when seeing a doctor for other diseases or routine physical examination.Hyperlipidemia is not infectious.
The treatment of hyperlipidemia mainly includes lifestyle intervention and drug treatment.Lifestyle changes include improving eating habits and increasing physical activity.The drug treatment mainly includes statinsBeite lipid-lowering drugs、nicotinic acidAnd high-purity fish oil.If the patient suffers from severe obesity at the same time, weight loss surgery can also be considered.Active treatment is beneficial to the prognosis of the disease, but it should be noted that hyperlipidemia has the risk of causing coronary heart disease, cerebrovascular disease and other complications.
In terms of research, the research progress of some new lipid-lowering drugs, such as lomitapide, a lipid transfer protein inhibitor, and mipomersen, an ApoB100 synthesis inhibitor, is expected to increase the variety of lipid-lowering drugs and improve the therapeutic effect.For patients who cannot tolerate statins, the inhibitor of PCSK9 becomes a possible treatment option in the future because of its significant effect on reducing low-density lipoprotein cholesterol.
TCM disease name
Hyperlipidemia
Foreign name
hyperlipidemia
Alias
Hyperlipidemia, dyslipidemia
Visiting department
Cardiology Department, Endocrinology Department, General Medicine Department
Multiple population
For people aged 50~69, men are higher than women before the age of 50, and women are higher than men after the age of 50
Most patients have no obvious symptoms of discomfort, and some patients may have xanthoma, early corneal ring, fundus changes, chest tightness, chest pain, dizziness, lameness and other symptoms
FatExcessive intakeLipoprotein synthesisAnd abnormal metabolic processDyslipidemiaAccording to the pathogenesis, hyperlipidemia can be divided into primary and secondary.
Primary hyperlipidemia
Primary hyperlipidemia is mostly related to gene mutation and has obvious genetic tendency, so it has family aggregation.
The cause of primary hyperlipidemia in a considerable number of people is unknown, which may be the result of the interaction between gene mutation and environmental factors.The related environmental factors are: bad eating habits, lack of physical activity, obesity, smoking, alcoholism and increasing age.
secondary hyperlipidemia
The dyslipidemia caused by other diseases and known causes is called secondary hyperlipidemia.
Long term use of certain drugs may cause hyperlipidemia:Glucocorticoid, thiazide diureticsBeta blocker, some anti-tumor drugs, etc.
In addition,estrogenDeficiency can also lead to hyperlipidemia.
symptom
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Hyperlipidemia generally has no obvious symptoms of discomfort, and most of them are found during medical treatment or routine physical examination due to other diseases. Some patients are diagnosed due to vascular disease complications.
Typical symptoms
Typical clinical manifestations of hyperlipidemia include:Xanthoma、Early-onset corneal ringFundus changes, but the incidence is not high, mostly in familial hypercholesterolemia patients.
Xanthoma
Lipids are deposited locally, often around the eyelids, and can be yellow, orange or brownish red, with soft texture.
Early-onset corneal ring
It usually occurs in people under 40 years old, located at the outer edge of the cornea, and is grayish white or white.
Fundus change
It is found in patients with severe hypertriglyceridemia.
Accompanying symptoms
Long term hyperlipidemia can lead to a series of accompanying diseases.
When atherosclerosis is caused, chest tightness, chest pain, dizziness, claudication and other symptoms may appear;
The symptoms of polydipsia and polyuria may occur when diabetes is caused;
Excess lipid deposits in the liver and spleen, and patients have increased liver and spleen volume.
Medical treatment
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Most hyperlipidemia is found in medical treatment or routine physical examination due to other diseases.
When abnormal blood lipid is found, the doctor will focus on whether the patient hascoronary heart disease、Cerebrovascular diseaseAnd symptoms of peripheral artery diseases, such as chest pain, shortness of breath, weakness, dyspnea or claudication. It is helpful for diagnosis and treatment to ask the patient about his family history, diet and exercise.
Regular blood lipid testing is recommended for the following people:
Have a history of cardiovascular and cerebrovascular diseases;
People with cardiovascular disease risk factors, including hypertension, diabetes, smoking, excessive drinking, obesity;
Family history of early onset cardiovascular disease;
Familial hyperlipidemia;
The skin or tendon has xanthoma.
diagnostic criteria
Abnormal blood lipid can be diagnosed when the following fasting venous plasma examination indexes are ≥ 1:
TC ≥ 5.2mmol/L and LDL-C ≥ 3.4mmol/L are defined as marginal elevation, which is intended to remind patients to strengthen blood lipid detection.
Visiting department
Dyslipidemia is a multidisciplinary medical model, especially in China.For those with abnormal blood lipid, xanthoma and other typical symptoms found in physical examination, priority should be given to cardiology or endocrinology.In grass-roots hospitals, general medicine or internal medicine can also be selected.
Some patients suffer from long-term lipid depositionatherosclerosisIn case of symptoms of cardiovascular and cerebrovascular diseases such as chest tightness and shortness of breath, we can choose the Department of Cardiology.But many children with hyperlipidemia should choose paediatrics.
Relevant inspection
General inspection
The doctor will take blood from the patient on an empty stomach to determine the levels of TC, HDL-C, LDL-C and TG in the fasting venous plasma, so as to make clear the diagnosis of hyperlipidemia and the severity of blood lipid rise, and guide the treatment.The patient should have an empty stomach for 12-14 hours before the blood lipid examination, and abstain from high-fat food and alcohol at the last meal.
Special inspection
Apolipoprotein A（ApoA）、Apolipoprotein B（ApoB）、Lipoprotein (a)[Lp (a)] has certain significance in predicting coronary heart disease.For primary hyperlipidemia, doctors will further clarify the cause through gene testing and lipid metabolism related enzymology.
differential diagnosis
The differential diagnosis of hyperlipidemia mainly lies in the differentiation of primary dyslipidemia and secondary dyslipidemia. Secondary dyslipidemia mostly has its primary clinical manifestations.
This is a primary dyslipidemia, which is an autosomal hereditary disease. Its onset is familial aggregation, and has the following characteristics: high and low density lipoprotein cholesterol, premature coronary heart disease, tendon and skin xanthoma.
That is commonly referred to as fatty liver, which is secondary dyslipidemia.Generally, there are no obvious symptoms, and a few patients may have mild symptoms such as fatigue, right upper abdomen distension, pain and discomfort.Severe fatty liver can cause nausea, vomiting, anorexia, jaundice and other symptoms, as well as hepatomegaly.
The transaminase may be slightly elevated when checking the liver function, and ultrasonic examination is generally feasible to assist in diagnosis.
treatment
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The treatment of hyperlipidemia mainly includes lifestyle intervention and drug treatment.Lifestyle intervention is the basic treatment measure, and secondary dyslipidemia is mainly to treat the primary disease.
Hyperlipidemia is a key factor in the occurrence and development of atherosclerotic cardiovascular disease, and the increase of low-density lipoprotein cholesterol (LDL-C) has the greatest impact.Therefore, the control of LDL-C level is often taken as the primary goal of hyperlipidemia treatment in clinical practice to reduce the morbidity and mortality of cardiovascular diseases.
Treatment principles and objectives
Individualized treatment goals can be determined according to the risk stratification of abnormal blood lipid profile. The greater the general risk, the more stringent the requirements of lipid regulation treatment.It is worth noting that there is a significant downward trend in the LDL-C target value. The new consensus is to reduce the LDL-C target value of high-risk patients to<1.4 mmol/L (55 mg/dl).
The risk stratification of dyslipidemia is shown in the table below.
Hazard stratification
TC5.18~6.19mmol/L or LDL-C3.37~4.14mmol/L
TC ≥ 6.19mmol/L or LDL-C ≥ 4.14mmol/L
No hypertension and other risk factors<3
Low risk
Low risk
Number of hypertension or other risk factors ≥ 3
Low risk
Moderate risk
Hypertension and other risk factors ≥ 1
Moderate risk
high-risk
Coronary heart disease and other dangerous diseases
high-risk
high-risk
Acute coronary syndrome
Very high risk
Very high risk
Ischemic cardiovascular disease with diabetes
Very high risk
Very high risk
Note: Other risk factors include age (male ≥ 45 years old, female ≥ 55 years old), smoking, low high-density lipoprotein cholesterol (HDL-C), obesity, and early ischemic cardiovascular disease history.
According to total cholesterol (TC) and LDL-C, therapeutic lifestyle change (TLC) or drug adjustment treatment and its target value are formulated.
Hazard level
TLC Start
Start of medication
Treatment target value
Very high risk
TC≥6.21mmol/LLDL-C≥4.14mmol/L
TC≥6.99mmol/LLDL-C≥4.92mmol/L
LDL-C＜4.14mmol/L（160mg/dl）
high-risk
TC≥5.2mmol/LLDL-C≥3.41mmol/L
TC≥6.21mmol/LLDL-C≥4.14mmol/L
LDL-C＜3.41mmol/L（130mg/dl）
Moderate risk
TC≥4.14mmol/LLDL-C≥2.6mmol/L
TC≥4.14mmol/LLDL-C≥2.6mmol/L
LDL-C＜2.6mmol/L（100mg/dl）
Low risk
TC≥4.14mmol/LLDL-C≥2.07mmol/L
TC≥4.14mmol/LLDL-C≥2.07mmol/L
TC＜3.1mmol/LLDL-C
General treatment
The doctor will guide the patient's lifestyle, including diet, exercise and other aspects. The patient needs to adhere to the therapeutic lifestyle change (TLC) program for a long time.
Keep exercising, control weight, and reach or close to the standard weight.
other
Quit smoking, limit salt intake, limit alcohol consumption, and prohibit alcohol.
medication
Doctors will choose different kinds and doses of drugs according to the risk assessment of patients with dyslipidemia, the characteristics of dyslipidemia and the mechanism of drug lipid regulation.For severe hyperlipidemia, in order to obtain good curative effect, it is usually necessary to combine multiple lipid regulating drugs.
Lipid regulating drugs can be divided into drugs that mainly reduce cholesterol and drugs that mainly reduce triglycerides according to the composition of reducing blood lipids.
Major cholesterol lowering drugs
Statins
It plays a role by inhibiting cholesterol synthesis and accelerating LDL clearance.Commonly used clinically, such aslovastatin、Simvastatin、AtorvastatinIf an adverse reaction occurs after taking one statin, the dosage can be reduced, another statin can be used, or non statin lipid-lowering drugs can be used instead.
Patients with decompensated cirrhosis and abnormal liver function (transaminase increased more than 3 times) should be cautious, and those with acute liver failure should not use it.
Other cholesterol lowering drugs
Yizhemai cloth: Inhibits the absorption of cholesterol in the intestine, and is forbidden during lactation and pregnancy.
Probuco: It can be used to alleviate xanthoma of the skin, and can have gastrointestinal reactions, dizziness, headache and other adverse reactions.Arrhythmia and hypokalemia are forbidden.
Drugs that mainly reduce triglycerides
Beite lipid-lowering drugs
It is mainly used for hypertriglyceridemia and mixed hyperlipidemia mainly with elevated triglycerides, and can increase HDL-C levelfenofibrate、BenzafibrateThe adverse reactions were similar to those of statins.Beite drugs can increase the effect of anticoagulants, and should pay attention to adverse reactions when used together with anticoagulants.It is forbidden for children, pregnant women and lactating women with abnormal liver and kidney functions.
Other drugs to reduce TG
nicotinic acidVitamin B3 is forbidden to be used for chronic liver disease, active peptic ulcer and severe gout. At present, it has been rarely used in European and American countries.
High purity fish oil: the main ingredients areUnsaturated fatty acid, less adverse reactions, digestive tract symptoms may occur in a few patientstransaminaseandcreatine kinaserise.It is forbidden for those with bleeding tendency.
The vascular protective effects of these two drugs need to be further studied.
surgical treatment
For patients with hyperlipidemia and severe obesity, doctors can arrange different weight reduction operations according to the situation.
TCM treatment
Traditional Chinese medicine has a unique understanding of the treatment of hyperlipidemia, and TCM diagnoses dyslipidemia as "turbid blood".
According to the meridian theory, reasonable acupoint compatibility and appropriate manipulation can be selected according to different stages and syndromes, includingauricular needling、body acupuncture、Abdominal acupunctureEtc.
Other treatments
For patients with severe refractory hyperlipidemia and completely intolerant to lipid-lowering drugs, doctors can use lipoprotein plasma exchange treatment.
Frontier treatment
The research on microsomal total cholesterol (TC) transfer protein inhibitors (such as lomitapide), ApoB100 synthesis inhibitors (such as mipomersen), preprotein invertase subtilisin 9 (PCSK9) inhibitors and other new lipid-lowering drugs is expected to increase the variety of lipid-lowering drugs.
Among them, the preprotein invertase subtilisin 9 (PCSK9) inhibitor has a very significant effect on reducing LDL-C, up to 70%. It is expected to be used in high-risk patients with statin intolerance, treatment failure or high LDL-C level in the future.
prognosis
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After active comprehensive treatment, the prognosis of hyperlipidemia is good.However, it should be noted that hyperlipidemia can lead to coronary heart disease and other diseases, and increase the risk of stroke. Active prevention and treatment is of great significance for reducing the incidence of cardiovascular disease and improving the quality of life.
Hyperlipidemia leads to impaired glucose tolerance anddiabetes。
Hyperlipidemia is combined with multiple metabolic disorders (obesity, diabetes, hypertension, cardio cerebrovascular diseases, etc.), which is calledMetabolic syndrome。
A few patients may even form emboli to block pancreatic capillaries due to hyperlipidemia (TG>10mmol/L)acute pancreatitis。
