Hu Dayi: Three groups of people need to strengthen blood lipid management as soon as possible to reduce the risk of cardiovascular disease

Expert: Hu Dayi, Director of the Institute of Cardiovascular Diseases, Peking University People's Hospital

Today, cardiovascular disease has become the number one cause of death in our population (1). Practice has proved that on the basis of a healthy lifestyle, active prevention and control of risk factors can effectively delay or avoid the occurrence of cardiovascular events.

Among the many high-risk factors, dyslipidemia should be particularly alarmed. Professor Hu Dayi, director of the Institute of Cardiovascular Diseases of Peking University People's Hospital, particularly reminded that there are three major groups of people who should pay special attention to the monitoring and management of blood lipids, including diabetic patients over 40 years old, elderly hypertension patients with a history of smoking or obesity, and people with dyslipidemia. Professor Hu Dayi stressed that patients need to achieve the ideal goal of low-density lipoprotein cholesterol (LDL-C) below 2.6mmol/L (100mg/dL) as soon as possible and as soon as possible through the dual means of lifestyle changes and drug therapy.

Cardiovascular disease has become the "number one killer" of health, and it is necessary to strengthen the management of blood lipids

Globally, cardiovascular disease is the "number one killer" that threatens human health, ranking first among the global causes of death (2). With the development of social economy, the prevalence of cardiovascular disease in China has continued to rise. Professor Hu Dayi pointed out that coronary heart disease, myocardial infarction, stroke and other cardiovascular diseases are the first causes of death in China's population (1), which has become a major public health problem that threatens the lives and health of Chinese residents.

According to the data of China's first "Guidelines for the Primary Prevention of Cardiovascular Diseases in China" released in December 2020, 4 million people die from cardiovascular diseases every year in China, accounting for more than 40% of the total deaths, that is to say, 40% of the total deaths in China each year are cardiovascular disease patients (3).

"Hyperlipidemia (hypercholesterolemia) is one of the pathogenic risk factors for atherosclerotic cardiovascular disease (ASCVD), but the rate of blood lipid control in China is less than 30%, and it is urgent to strengthen blood lipid management." Professor Hu Dayi said.

China's first "Guidelines for the Primary Prevention of Cardiovascular Diseases in China" came into being. What is the "primary prevention" of cardiovascular disease? Professor Hu Dayi introduced that the primary prevention of cardiovascular disease refers to the preventive measures to reduce the risk of cardiovascular clinical events by controlling the main risk factors of cardiovascular diseases such as smoking, hypertension, dyslipidemia and diabetes before the occurrence of cardiovascular events such as acute myocardial infarction and stroke (4). It can be seen that the prevention and control of risk factors is the core of the primary prevention of cardiovascular disease.

Diabetics: after the age of 40, regular urine glucose and blood lipids are checked every year

In people with diabetes mellitus who develop complications of dyslipidemia, their risk of cardiovascular events increases accordingly. Studies have shown that patients with diabetes mellitus with dyslipidemia have a 1.9-fold increased risk of myocardial infarction, a 2-fold increase in the risk of cerebral hemorrhage, and a 2.3-fold increase in cerebral infarction (5) compared with patients with diabetes alone (5).

Data indicate that more than 60% of patients with type 2 diabetes have dyslipidemia (6). At present, the "Guidelines" have directly listed diabetic patients aged 40 and above as high-risk groups for cardiovascular disease, and Professor Hu Dayi suggested that diabetic patients over 40 years old should regularly check urine glucose, blood lipids and other indicators every year. The incidence of dyslipidemia in diabetic patients is higher than that of ordinary people, and it needs to be more strictly controlled. Usually pay special attention to lifestyle changes. If diabetic patients find dyslipidemia, lifestyle intervention can not make the blood lipids up to standard, need to carry out timely drug treatment, in order to effectively prevent the onset of cardiovascular and cerebrovascular diseases, to ensure a healthy life.

Patients with hypertension: lipid management should be started as early as possible

Once patients with hypertension develop complications of dyslipidemia, their risk of cardiovascular events increases by 3-4 times (7). Studies have shown that in China, the number of patients with hypertension and dyslipidemia is as high as 61.5% (8). However, most patients with hypertension are not aware of their own dyslipidemia problems, and management awareness needs to be improved.

In this regard, Professor Hu Dayi especially reminded: "Hypertension combined with elevated blood lipids, the biggest harm is to lead to myocardial infarction and cerebral infarction and other cardiovascular and cerebrovascular diseases." For patients with hypertension under 70 years of age, if some risk factors are combined, such as smoking, obesity, microalbuminuria, etc., they are all high-risk groups of cardiovascular disease, and special attention should be paid to lifestyle changes such as smoking cessation, weight loss, exercise, reasonable diet, etc., such as finding dyslipidemia in time to seek medical evaluation and start drug intervention. By the age of 70 or even older, as long as there is hypertension, you should follow the guidelines for cardiovascular disease risk assessment as soon as possible, and immediately begin to actively control risk factors3, while improving lifestyle while paying attention to active medication treatment. “

In addition, Professor Hu Dayi stressed that patients with hypertension and dyslipidemia should review blood lipids, check liver function and creatine kinase and other indicators, on the one hand, they can assess their own blood lipid standards, on the other hand, they can also monitor the adverse reactions of drugs.

Statin drug intolerant population: natural lipid adjustment method can be selected

Statins are essential drugs for many people with dyslipidemia and atherosclerotic cardiovascular disease. Professor Hu Dayi pointed out that the Chinese population with dyslipidemia has its own characteristics, mainly manifested as: First, the vast majority of Chinese patients have a baseline low-density lipoprotein cholesterol (LDL-C) level below 3.4 mmol/L, and are intolerant to large doses of statin. Second, Chinese group is more "sensitive" to statins than Western populations (9).

For patients with tanthin intolerance, natural lipid modulation is a good choice. The first thing to do is to pay attention to having a good lifestyle, including adhering to a healthy diet, exercising regularly, staying away from tobacco, avoiding overeating, and maintaining an ideal weight. Eat a healthy diet that emphasizes vegetables, fruits, nuts, whole grains, lean or animal proteins and fish, and minimizes intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages.

Lifestyle changes should also be accompanied by timely drug interventions based on lipid testing and assessment. Professor Hu Dayi shared his medical experience in international hospitals, he said that not only Chinese patients, but also some foreign patients will choose natural lipid adjustment methods when they are intolerant of statin. In addition, for patients with elevated liver enzymes, fatty liver disease or other chronic liver diseases, it is safer to choose natural lipid adjustment methods and patient acceptance is higher.

In high-risk populations, moderate and long-lasting management is key

The Guidelines state that studies have confirmed that the lower and longer the duration of LDL cholesterol reductions, the greater the risk of cardiovascular disease, regardless of the method used.

So, how do high-risk groups manage blood lipids? Professor Hu Dayi gave 4 key words:

The first: healthy living. Primary prevention of ASCVD first recommends a healthy lifestyle, including diet, physical activity, weight control, smoking cessation, and alcohol restriction. Among them, diet has the greatest impact on blood lipid levels, healthy diet is the key to reducing "bad cholesterol (low-density lipoprotein)", it is recommended to limit the intake of saturated fatty acids and trans fatty acids, and increase the intake of fruits and vegetables, grains and potatoes and fish. Pharmacotherapy should be considered when lifestyle improvements do not meet the standard of blood lipids.

The second: long-term strict control. Strict control of risk factors, all high-risk groups of cardiovascular disease, do not only stare at their own blood pressure, blood sugar, weight indicators, even if their own physical examination test sheet on the blood lipids show normal, can not be taken lightly, must be "bad cholesterol (low density lipoprotein)" strictly guarded, it long-term control at a relatively low standard. "Bad cholesterol" is closely related to myocardial infarction. The indicators of "bad cholesterol" in different groups are different, so there is no "↑" on the test list and it should not be taken lightly, but more should pay attention to the target value of their "bad cholesterol". Severely elevated "bad cholesterol" (>4.9 mmol/L), patients with diabetes mellitus over 40 years old, patients with hypertension with multiple risk factors, etc., belong to high-risk groups, and "bad cholesterol" should be controlled below 2.6 mmol/L; for those who have been clearly diagnosed with coronary heart disease, they should be controlled at 1.8 mmol/L and below (10). At the same time, the lower the level of "bad cholesterol", the better the effect of preventing cardiovascular disease.

The third: regular testing. It is recommended that men over 40 years of age and women after menopause be tested for blood lipids at least once a year; patients with atherosclerotic diseases and their high-risk groups should be tested for blood lipids every 3 to 6 months; those who take lipid-modulating drugs for the first time should review blood lipids, liver and kidney function and muscle indicators within 6 weeks of medication. If the blood lipids can reach the target value and there are no adverse drug reactions, gradually change to a repeat every 6 to 12 months, and if the blood lipids are not up to standard and there are no adverse drug reactions, monitor once every 3 months (11).

Fourth: Mild fat tone. For the intervention and treatment of dyslipidemia, the emphasis is on a "tone" word, especially some elderly patients with various chronic diseases, more attention should be paid to the gentle and natural lipid adjustment method, taking into account the effectiveness and safety.

Disclaimer: This material is only used as popular science education material for public diseases, does not make any recommendation, and is not used for any promotional purposes.

Resources:

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⑤Fan D,etal. Lipids Health Dis. 2018 May 8;17(1)102

(6)Yan L, et al. J Clin Lipidol. 2016;10(1):150-60.

(7) Chinese Guidelines for the Prevention of Cardiovascular Diseases (2017) Writing Group. Chinese Journal of Cardiovascular Diseases,2018,01:10-25.

(8) LI Yong, et al. Chinese Journal of Cardiovascular Diseases,2016,44(8):665-670

(9) Joint Committee on the Revision of Guidelines for the Prevention and Treatment of Dyslipidemia in Adults in China. Chinese Guidelines for the Prevention and Treatment of Dyslipidemia in Adults (Revised Edition 2016).Chinese Journal of General Practitioners,2017,16(1):15-35.

(10) "Core Tips for "Managing Cholesterol and Preventing Myocardial Infarction""

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