Advanced treatments for hyperlipidemia: probucol, niacin, fish oil, blood purification, and surgery.
**13. Probucol (Propylbutyrol)**
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[Efficacy]This product is a bile acid inhibitor that can effectively reduce serum total cholesterol levels and has a certain effect on reducing low-density lipoprotein.
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[Indications]Type II hyperlipoproteinemia.
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> [Usage]The usual dosage is 0.2 to 0.5 grams each time, twice a day, taken with breakfast and dinner.
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> [Precautions]
> (1) Occasionally, gastrointestinal discomfort symptoms such as abdominal pain, diarrhea and nausea may occur after taking the medicine.
(2) During medication, serum transaminase, alkaline phosphatase and creatine kinase levels may occasionally increase; bilirubin, uric acid, blood urea nitrogen and blood glucose may show transient increases.
(3) This product is contraindicated in patients with hypokalemia or arrhythmia.
(4) During medication, regular electrocardiogram (ECG) examinations are required.
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**14. Niacin (Nicotinic Acid)**
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[Efficacy]This product is a niacin-based lipid-lowering drug and also belongs to the B vitamins and vasodilators. It has a significant effect on lowering triglycerides, and also has a good effect on lowering serum total cholesterol and low-density lipoprotein, while slightly increasing high-density lipoprotein levels.
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> [Indications]Any type of hyperlipidemia except for homozygous familial hypercholesterolemia and type I hyperlipoproteinemia.
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> [Usage]The initial dose is 50-100 mg each time, 3 times a day, taken with meals.
After 2-3 weeks of medication, the dosage can be gradually increased to the usual amount: 1-2 grams each time, 3 times a day.
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> [Precautions]
(1) In the early stages of medication, strong skin redness and itching are likely to occur, but these symptoms can be gradually relieved after several weeks of continued treatment.
(2) This product may induce peptic ulcers, impaired glucose tolerance, increased blood uric acid, and gout.
(3) High doses can cause liver damage and jaundice. If these symptoms are found, the medication must be stopped immediately.
(4) This product can enhance the vasodilatory effect of antihypertensive drugs and may cause orthostatic hypotension when used in combination with antihypertensive drugs.
> (5) Use with caution in patients with diabetes, peptic ulcer, or liver disease.
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**15. Acilimex (Lysoxepin)**
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[Efficacy]This product is a derivative of niacin, which can effectively reduce serum triglyceride and serum total cholesterol levels, and can also increase high-density lipoprotein levels.
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[Indications]Hyperlipoproteinemia, diabetic dyslipidemia.
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> [Usage]The usual dosage is 250 mg each time, 2 to 3 times a day, taken after meals.
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> [Precautions]
> (1) Adverse reactions such as skin flushing, heat, and itching may occur in the early stage of medication, which will disappear on their own after a few days.
(2) Occasionally, gastrointestinal discomfort, headache, and weakness may occur during medication.
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**16. Fish Oil Preparations**
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[Efficacy]This product is a polyunsaturated fatty acid preparation, which can effectively reduce serum triglyceride levels and can also slightly increase high-density lipoprotein.
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> [Indications]Hypertriglyceridemia.
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> [Usage]The usual dosage is 1.8 grams each time, 3 times a day.
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> [Precautions]
> (1) Nausea is common due to the fishy smell, which makes it difficult for most patients to continue taking the medication.
(2) Long-term use of free fatty acid type fish oil preparations can easily cause gastrointestinal bleeding.
(3) This product is contraindicated in patients with bleeding tendencies.
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**17. Panthenylthioethylamine (Panterson)**
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[Efficacy]This product has a moderate lipid-lowering effect, and can reduce serum total cholesterol and triglycerides and increase high-density lipoprotein.
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> [Indications]Hyperlipidemia.
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> [Usage]The usual dosage is 0.2 grams each time, 3 times a day.
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> [Precautions]
(1) Occasionally, gastrointestinal discomfort reactions such as diarrhea, loss of appetite, abdominal distension and vomiting may occur during medication.
(2) Use with caution in pregnant women.
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**18. Standard Double Filtration Method**
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> [Efficacy] This method belongs to the blood purification therapy for hyperlipidemia, which can effectively reduce serum low-density lipoprotein level by 48%.
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[Indications]Refractory hypercholesterolemia, coronary atherosclerosis.
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[Usage]Use two filters with different pore sizes: one as a plasma separator for plasma separation; the other as a plasma filter to retain and discard antibodies, immune complexes, low-density lipoproteins, etc. in the separated plasma.
Finally, the filtered and purified blood and blood cells are returned to the patient's body, along with an equal amount of replacement fluid.
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[Precautions]This treatment is not suitable for all patients with hyperlipidemia; it must be based on the doctor's diagnosis and advice.
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**19. Heated Double Filtration Method**
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[Efficacy]This method belongs to the filtration method in the blood purification therapy for hyperlipidemia. It can effectively reduce the level of serum low-density lipoprotein and significantly reduce the ratio of low-density lipoprotein to high-density lipoprotein.
This method is more effective than the ordinary double filtration method, and can greatly reduce the possibility of filtering albumin, anticoagulants and high-density lipoprotein.
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[Indications]Refractory hypercholesterolemia, coronary atherosclerosis.
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[Usage]Use two filters with different pore sizes. Use the first filter as a plasma separator. Heat the filtered plasma to 39°C and then pass it through the second filter to remove antibodies, immune complexes, low-density lipoprotein, and other substances from the plasma.
Finally, the filtered and purified blood and blood cells are returned to the patient's body, along with an equal amount of replacement fluid.
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[Precautions] Similarly, this treatment is not suitable for all patients with hyperlipidemia; it must be based on the doctor's diagnosis and advice.
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**20. Immunosorbent Assay**
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[Efficacy] This method belongs to the adsorption method in the blood purification therapy for hyperlipidemia. It can effectively reduce serum low-density lipoprotein level by 80% and blood very low-density lipoprotein level by 50%.
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[Indications]Refractory hypercholesterolemia, coronary atherosclerosis.
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[Usage]Plasma is drawn from the elbow vein, passed through a blood cell separator to separate the plasma and blood cells, and the blood cells are immediately returned to the patient, while the plasma is transfused into another tube containing an adsorbent.
Immunosorbent therapy uses specific immunosorbents that adsorb low-density lipoproteins in the plasma and then reinfuse them into the patient's body.
Each treatment session takes 3 hours and needs to be repeated every 1 to 2 weeks.
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[Precautions]This therapy has few adverse reactions and high specificity, but requires lifelong treatment.
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**21. Heparin-Agarose Adsorption Method**
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[Efficacy] This method belongs to the adsorption method in the blood purification therapy for hyperlipidemia, which can effectively reduce serum low-density lipoprotein levels.
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[Indications]Refractory hypercholesterolemia, coronary atherosclerosis.
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[Usage]Plasma is drawn from the elbow vein, passed through a blood cell separator to separate the plasma and blood cells, and the blood cells are immediately returned to the patient, while the plasma is transfused into another tube containing an adsorbent.
The heparin-agarose adsorption method uses a binding agent of heparin and agarose. Low-density lipoprotein in plasma is adsorbed and then reinfused into the patient.
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[Precautions]The disadvantage of this method is that while it adsorbs low-density lipoprotein, it also adsorbs various components in the human body, such as antithrombin, coagulation factors, lipoprotein lipase, liver lipase, and high-density lipoprotein.
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**22. Dextran sulfate-cellulose adsorption method**
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[Efficacy]This method belongs to the adsorption method in the blood purification therapy for hyperlipidemia. It can achieve the therapeutic effect of reducing serum low-density lipoprotein level by 60% by adsorbing apolipoprotein B.
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[Indications]Refractory hypercholesterolemia, coronary atherosclerosis.
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[Usage]Plasma is drawn from the elbow vein, passed through a blood cell separator to separate the plasma and blood cells, and the blood cells are immediately returned to the patient, while the plasma is transfused into another tube containing an adsorbent.
The adsorbent used in the dextran sulfate cellulose adsorption method is dextran sulfate cellulose. After apolipoprotein B and low-density lipoprotein in the plasma are adsorbed, they can be reinfused into the patient's body.
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[Precautions]This method has few adverse reactions and good efficacy, and there is no need to replenish plasma after treatment. However, a small number of patients may not see significant effects after treatment.
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**23. Active hemoperfusion therapy**
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> [Efficacy] This method belongs to the perfusion method in the blood purification therapy for hyperlipidemia. Through treatment, it can significantly reduce serum triglyceride, low-density lipoprotein, and very low-density lipoprotein levels.
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[Indications]Refractory hypercholesterolemia, coronary atherosclerosis.
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[Usage]The extracted plasma is placed directly into the adsorption column and comes into contact with the activated carbon adsorbent, thereby removing certain components from the plasma to achieve the therapeutic purpose.
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[Precautions]This method can be effective for most patients, but may not be effective or may be ineffective for a small number of patients.
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**24. Beaded Agarose Hemoperfusion Method**
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[Efficacy]This method belongs to the perfusion method in the blood purification therapy for hyperlipidemia. Through treatment, it can selectively reduce the content of serum low-density lipoprotein, and can also reduce the levels of serum triglycerides and very low-density lipoprotein.
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[Indications]Refractory hypercholesterolemia, coronary atherosclerosis.
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[Usage]The extracted plasma is placed directly into the adsorption column to contact the adsorbent, thereby removing certain components from the plasma and achieving the therapeutic purpose.
The adsorbent used in this method is bead-shaped agarose.
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[Precautions] This method is generally only suitable for selective treatment of refractory hypercholesterolemia.
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**25. Heparin Precipitation Method (Heparin Low-Density Lipoprotein Precipitation Method)**
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[Efficacy]This method belongs to the blood purification therapy for hyperlipidemia. It can efficiently, safely and well-toleratedly remove low-density lipoprotein from the serum, while significantly reducing serum total cholesterol levels.
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[Indications]Severe hypercholesterolemia, coronary atherosclerosis.
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[Usage]Draw blood at a rate of 50 ml per minute. After passing through a fiber filter, immediately reinfuse the blood cell components into the patient. Then mix the plasma with an equal volume of heparinized acetate buffer. After the low-density lipoprotein is precipitated, remove it by passing it through a polycarbonate membrane filter.
Subsequently, the plasma, from which low-density lipoprotein has been removed, is pumped into the heparin adsorption chamber to remove anticoagulants, salts, and water, before being reinfused into the patient.
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[Precautions] This method is generally only suitable for selective treatment of refractory hypercholesterolemia.
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**26. Liver Transplantation**
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[Efficacy] Liver transplantation is a surgical treatment for hyperlipidemia and can effectively reduce serum total cholesterol levels.
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> [Indications]Hypercholesterolemia.
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> [Indications]
> (1) The patient has no or almost no low-density lipoprotein receptor function.
(2) Even after conservative treatment, the patient still has the dynamic of atherosclerosis development.
(3) The patient's physical condition is relatively stable and he/she can withstand surgery.
(4) The patient does not have any other diseases that could threaten his or her life.
(5) The patient’s family income is stable.
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> [Precautions]
> (1) Liver transplantation is not only expensive, but also has a high rate of disability and mortality.
(2) After surgery, patients need to take immunosuppressive drugs for life in order to avoid rejection of the transplanted liver.
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**27. Partial Terminal Ilex Resection**
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[Efficacy] Liver transplantation is a surgical treatment for hyperlipidemia, which can effectively reduce serum total cholesterol and low-density lipoprotein levels; at the same time, it can increase the ratio of high-density lipoprotein to serum total cholesterol and the ratio of high-density lipoprotein to low-density lipoprotein.
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[Indications]Hyperlipidemia, especially effective for patients with heterozygous hyperlipoproteinemia.
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> [Indications] This treatment is suitable for patients with hyperlipidemia whose condition does not respond well to other treatments.
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> [Precautions]
(1) This surgery has a poor therapeutic effect on homozygous familial hypercholesterolemia.
> (2) After the surgery, complications such as diarrhea, kidney stones, gallstones and intestinal obstruction may occur.
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**28. Portocaval shunt anastomosis**
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[Efficacy] This surgery is a surgical treatment for hyperlipidemia and has a certain effect on reducing serum total cholesterol levels. At the same time, most patients will experience a significant reduction or even complete disappearance of the tendency for arteriosclerosis after treatment.
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[Indications]Hypercholesterolemia, coronary atherosclerosis.
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> [Indications] Especially suitable for homozygous familial hypercholesterolemia.
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[Precautions] Some patients still have significant hypercholesterolemia after treatment.
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