Hyperlipidemia has the highest incidence among the “three highs.” Among adults in our country, 40% of people have lipid problems. Although hyperlipidemia has a high incidence, people’s attention to it is far less than that to hypertension and diabetes.
What you may not know is that elevated lipids can pose no less harm to the human body than diabetes and hypertension. Prolonged high levels of lipids can lead to atherosclerosis, trigger ischemic diseases such as heart disease and stroke, and even lead to lower limb arterial occlusion, posing a risk of amputation.
For the treatment of hyperlipidemia, one needs to start from both medication and lifestyle adjustments. However, in real life, many people simply rely on medication to lower lipids while not paying enough attention to lifestyle. This approach is incorrect. Today, let’s focus on this topic.
What is the core of lipid-lowering treatment?
Lipids refer to lipid substances in the blood, with cholesterol being the most harmful component to the human body. Therefore, the core of lipid-lowering treatment is to reduce cholesterol levels, especially low-density lipoprotein cholesterol levels. Statin drugs are commonly used in clinical practice, mainly inhibiting cholesterol synthesis in the liver.
The characteristics of statins include affordability, stable efficacy, and the ability to achieve good results with small doses. For example, with atorvastatin, many people only need to take 10 milligrams to achieve ideal lipid levels.
In addition to statins, there are many other lipid-lowering drugs in daily life, but most of them are used in combination with statins and rarely applied alone, such as ezetimibe, PCSK9 inhibitors, etc.
Why shouldn’t lipid-lowering rely solely on medication?
Due to medical advancements and drug development, people have changed their proactive health care awareness and emphasis on healthy lifestyles, shifting this responsibility to doctors and medications. This approach is incorrect for the treatment of hyperlipidemia.
Cholesterol in the body mainly comes from two sources: one is absorbed from food, accounting for about 20% of the total cholesterol; the other is synthesized by the liver itself, accounting for about 80% of total cholesterol.
Hence, if lipids are high, relying solely on dietary control, most patients cannot achieve ideal levels. So, can medication alone bring lipid levels to ideal ranges?
This idea is also incorrect because liver synthesis and food absorption influence each other. When one pathway is inhibited, the other pathway reflexively increases, leading to elevated cholesterol levels again.
When this situation occurs, it necessitates increasing the medication dosage to further inhibit cholesterol synthesis in the liver to achieve good results.
However, statin drugs have a characteristic of 6%, meaning that doubling the dose will only increase the effectiveness by 6%. Meanwhile, the occurrence rate of side effects steadily rises with increasing drug dosage.
The main side effects of statins include liver damage, increased blood sugar, and muscle toxicity. Any of these effects have a significant impact on health. If any related side effects occur, the medication dosage needs to be reduced, or even the medication might need to be stopped, which could further compromise lipid control.
Many friends with hyperlipidemia have certain metabolic problems and are prone to concomitant metabolic diseases such as diabetes, hypertension, and hyperuricemia. These diseases can interact and aggravate each other, leading to various complications if not controlled in time.
Improving lifestyle plays a crucial role in treating all metabolic diseases. If all diseases rely on medications, the daily intake of drugs will significantly increase. This will raise the chances of side effects and interactions between drugs, negatively affecting the body.
What lifestyle considerations are important when lipid levels are elevated?
Healthy eating: Friends with hyperlipidemia are advised to consume a low-fat, low-calorie diet, limiting the intake of lipid substances, especially saturated and trans fats. Studies show that reducing cholesterol intake by 200 mg can lower blood cholesterol by about 4 mg/dl (0.1 mmol/L). Also, control calorie intake. Consuming excessive high-calorie substances that cannot be burned will convert to fat, raising lipid levels.
Weight control: Most friends with hyperlipidemia have weight issues. Increased weight can cause insulin resistance, further worsening lipid metabolism abnormalities. Therefore, friends with hyperlipidemia need to keep their weight within a normal range. Dr. Zhang suggests maintaining a BMI between 20-24, which is relatively safe. Many friends have normalized their lipids simply by losing weight. Adequate exercise: Proper exercise is a simple, practical, economical, and effective way to control lipids. Friends with abnormal lipids are advised to exercise 5-7 days a week, 30-60 minutes each time, combining moderate-intensity aerobic and resistance exercises, with resistance exercises conducted twice a week.
Avoid bad habits: Smoking, drinking, staying up late, and irregular schedules can affect hormone levels, cause hormonal imbalances, raise lipids, and increase the risk of cardiovascular diseases.
Avoid negative emotions: Negative emotions can also adversely affect hormone levels, cause hormonal imbalances, impact lipid metabolism, and raise lipid levels.
What is the ideal cholesterol level to maintain?
For an ideal lipid level, focus mainly on low-density lipoprotein cholesterol levels. Different individuals require different ideal levels.
If there are no other issues or bad habits present, and lipids are elevated, it is recommended to keep low-density lipoprotein cholesterol levels below 3.4, with the ideal level being below 2.6. Besides elevated lipids, if there are accompanying conditions such as hypertension, diabetes, hyperuricemia, smoking, drinking, obesity, etc., strive to keep lipid levels below 2.6.
If one has a history of cardiovascular ischemic diseases, low-density lipoprotein cholesterol levels should be kept below 1.8. If there are frequent cardiovascular events and a considerable number of risk factors, some doctors may suggest keeping low-density lipoprotein cholesterol levels below 1.4 or even 1, but further research in this area awaits confirmation through extensive data.
At what lipid level should lipid-lowering medication be started?
If low-density lipoprotein cholesterol levels are below 4.1, lifestyle improvements usually lead to ideal levels. If they exceed 4.1, achieving normal lipid levels solely through lifestyle changes is challenging, so medication is needed.
If low-density lipoprotein cholesterol levels exceed 4.9, the risk of developing cardiovascular diseases significantly rises. At this point, low-density lipoprotein cholesterol levels need to be kept below 1.8 for relative safety.
Moreover, these patients should consider whether they have familial hypercholesterolemia, as managing ideal levels with statins alone is difficult in such cases and may require combination therapy.
To sum up:
Hyperlipidemia is one of the “three highs” but has not received enough attention from friends. Many people rely solely on medication for treatment while continuing their usual lifestyles, which is incorrect.
Dr. Zhang suggests maintaining a healthy diet, quitting bad habits, exercising, maintaining a healthy weight, avoiding negative emotions, regularly checking lipid profiles, striving to control lipids within ideal ranges, to the greatest extent possible, to prevent the occurrence of cardiovascular diseases.
That’s all for today’s discussion. I am Dr. Zhang, and I’ll see you next time.
References
[1] Clarke R, Frost C, Collins R, et al. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ, 1997, 314(7074):112117. DOI: 10.1136/bmj.314.7074.112.
