Comprehensive Management Guidelines for Hyperlipidemia: Analyzing Etiological Factors, Diagnostic Criteria, and Classification and Treatment Strategies

3. What are the causes of hyperlipidemia? There are many causes of hyperlipidemia. Only by understanding these causes can we better prevent and treat hyperlipidemia. The causes of hyperlipidemia are as follows: (1) High-fat diet. Excessive fat intake in the diet is a common cause of hyperlipidemia. (2) Weight gain. Simple obesity and metabolic syndrome characterized by obesity and insulin resistance are also common causes of elevated plasma triglycerides and cholesterol. Weight gain not only promotes the synthesis of apolipoprotein B in the liver and increases the production of low-density lipoprotein, but also increases the synthesis of cholesterol in the body. (3) Aging. With increasing age, blood cholesterol levels rise and low-density lipoprotein breakdown decreases. (4) Estrogen deficiency. After menopause, women's blood cholesterol levels increase significantly. (5) Drug effects. Long-term use (especially high doses) of glucocorticoids, thiazide diuretics, β-blockers, etc., can also lead to abnormal blood lipids. (6) Unhealthy lifestyle habits. Many unhealthy lifestyle habits can cause blood lipid abnormalities, such as: high sugar diet, excessive drinking, smoking, and insufficient physical activity. (7) Gene defects. For example, the cause of familial hypercholesterolemia is a gene mutation related to lipid metabolism. (8) Systemic diseases. Such as type 1 diabetes, hypothyroidism, biliary obstructive diseases (such as gallstones, liver tumors, biliary cirrhosis and biliary atresia), kidney diseases (such as nephrotic syndrome), systemic lupus erythematosus, and multiple myeloma can all cause abnormal blood lipids.

4. What are the diagnostic criteria and treatment goals for hyperlipidemia? Having understood which components are affected by hyperlipidemia, you will certainly want to: be able to read your lab reports to know when to see a doctor and take lipid-lowering medication; know which medications are targeted at which lipid components; and know the effectiveness of your medications. Let's take a closer look at the diagnostic criteria and treatment goals for hyperlipidemia. Table 1: Diagnostic Criteria and Treatment Goals for Hyperlipidemia

Note: TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol.

5. What are the early signs of hyperlipidemia? People who consume too much high-fat and high-cholesterol food in their daily lives, those who are obese, those who suffer from diseases closely related to hyperlipidemia, such as fatty liver, high blood pressure, diabetes, or those with yellow patches on their buttocks or limbs, should go to the hospital for examination.

6. Are there symptoms of hyperlipidemia? Most patients with hyperlipidemia do not have obvious symptoms. Many people are diagnosed only during a blood test at a physical examination. However, some patients (especially those with familial hypercholesterolemia) may present with early symptoms and signs of coronary heart disease, and the cardiovascular disease progresses rapidly. A predisposition to pancreatitis and the appearance of xanthomas also suggest the possible presence of hyperlipidemia.

7. What are the dangers of hyperlipidemia? Although hyperlipidemia itself has few symptoms, it is a well-established risk factor for cardiovascular disease and can easily lead to complications such as atherosclerosis, coronary heart disease, cerebral infarction, and pancreatitis. Cardiovascular disease, in particular, not only occurs early but also progresses rapidly, posing a significant threat.

8. What are the treatment principles for hyperlipidemia? Patients with hyperlipidemia should first correct the secondary causes of lipid disorders, such as medications that cause lipid disorders, including diuretics, beta-blockers, and hormones. Secondly, the underlying diseases causing lipid disorders should be treated, such as hypothyroidism, liver disease, nephrotic syndrome, and diabetes. Other risk factors for coronary heart disease, such as hypertension, smoking, and obesity, should also be controlled. Simultaneously, lifestyle modifications should be made, such as a suitable diet and appropriate physical activity. If hyperlipidemia remains significant after 3–6 months of the above treatment, lipid-lowering drugs should be added.

9. What are the general treatments for hyperlipidemia? General treatment for hyperlipidemia mainly refers to lowering blood lipids by changing lifestyle factors, including diet, exercise, smoking and drinking habits, and behavioral habits. This mainly includes the following: (1) Weight loss. Most patients can correct their blood lipid disorders after losing weight. (2) Exercise. Physical exercise can enhance cardiopulmonary function, improve insulin resistance, improve glucose tolerance, reduce weight, lower plasma cholesterol and triglyceride levels, and increase high-density lipoprotein cholesterol. Aerobic exercises such as moderate-speed walking, jogging, swimming, rope skipping, aerobics, and cycling are recommended. (3) Quitting smoking. Quitting smoking can lower plasma cholesterol and triglyceride levels and increase high-density lipoprotein cholesterol. (4) Dietary therapy. Adjust the diet and control the intake of calories and sugars.

11. What factors affect the efficacy of lipid-lowering treatment? Many patients have had this experience: after being diagnosed with hyperlipidemia, they have taken lipid-lowering drugs for a considerable period of time under the guidance of a doctor, but their blood lipid levels remain high, to the point that they lose confidence in the treatment. In fact, everything has its reasons. Ultimately, the problem lies with the patient themselves! If you encounter a similar situation or need lipid-lowering treatment, you may wish to carefully read the following content. (1) Inadequate diet control. Hyperlipidemia is closely related to diet, especially hypertriglyceridemia, which is closely related to diet. If diet is not strictly controlled, the treatment effect will be greatly reduced. (2) Insufficient exercise. (3) Failure to adhere to the prescribed medication schedule. (4) Failure to control smoking. (5) For patients with secondary hyperlipidemia, their primary disease has not been properly treated and controlled.

12. What diseases and medications affect blood lipids? There are many factors that affect blood lipids! In addition to those mentioned above, many other diseases and medications can also affect blood lipid levels. Perhaps one of them is the source of your problem! (1) The lipid metabolism disorder caused by non-insulin-dependent diabetes mellitus is characterized by mild hypertriglyceridemia and low high-density lipoprotein cholesterol levels. Hypoglycemic drugs can generally lower serum cholesterol and triglyceride levels. (2) In hyperthyroidism, serum cholesterol and low-density lipoprotein cholesterol levels often decrease, while all patients with hypercholesterolemia should be excluded from hypothyroidism. (3) Liver diseases such as hepatitis and fatty liver, as well as kidney diseases, can all affect blood lipid levels. (4) Hypertensive patients with hyperlipidemia should avoid using β-blockers and thiazide diuretics as much as possible. It has been reported that β-blockers can increase total cholesterol levels and decrease high-density lipoprotein cholesterol levels. Thiazide diuretics can increase plasma triglyceride and low-density lipoprotein cholesterol levels. (5) Women over 50 years of age have elevated serum cholesterol levels. Women taking estrogen or estrogen-containing contraceptives have higher apolipoprotein AI levels than women not taking any estrogen. (6) Lipid-lowering drugs such as bile acid sequestrants can increase triglyceride levels, and niacin can decrease glucose tolerance; therefore, they should be used with caution.

13. What are the principles of a reasonable dietary structure? You surely know that blood lipids are closely related to diet. But do you know specifically what foods are beneficial for lowering blood lipids and what foods are detrimental? In fact, with so many types of food, no one can possibly remember them all. However, you must grasp the following principles: Food should be varied, meals should be moderate, oil intake should be moderate, refined and whole grains should be balanced, salt intake should be limited, sweets should be eaten sparingly, alcohol consumption should be moderate, and meals should be balanced. A reasonable dietary structure is best with carbohydrates accounting for 50%–60% of total calories, protein 10%–20%, and fat 25%–30%. Fish is rich in polyunsaturated fatty acids, which help prevent atherosclerosis. Oats and black fungus have significant blood lipid-lowering effects. Moderate amounts of lean meat, vegetable oil, soy products, and fresh vegetables and fruits can be consumed.

14. What are the principles for selecting lipid-lowering drugs? There are many types of lipid-lowering drugs on the market, which can be dazzling. However, they can all be classified into several main categories. Each type of drug has its own characteristics, indications, adverse reactions and precautions for taking it. Friends who are undergoing lipid-lowering treatment must understand which category the drug they are using belongs to, so as to be clear about their treatment. First, you should understand which type of dyslipidemia you have. According to the lipid classification, under the guidance and monitoring of a doctor, select the appropriate lipid-lowering drug. (1) Simple cholesterol elevation, including elevated plasma total cholesterol and low-density lipoprotein cholesterol, HMG-CoA reductase inhibitors (i.e., statins, such as simvastatin, prazolam, levofloxacin, atorvastatin, etc.) are the best choice. Bile acid sequestrants and probucol (propofol) can also be used. (2) For isolated triglyceride elevation, phenoxyaromatic acids (such as chlorhexidine, chlorhexidine, etc.) or niacin (such as benzoyl peroxide, niacin, etc.) can be used, or linoleic acid derivatives, such as fish oil preparations like polyene-based supplements, can also be used. (3) For significantly elevated cholesterol, accompanied by mild to moderate elevation of triglycerides, HMG-CoA reductase inhibitors should be used. (4) For significantly elevated triglycerides, accompanied by mild elevation of total cholesterol, phenoxyaromatic acids or niacin should be used. It is worth noting that statins should not be used in combination with phenoxyaromatic acids to avoid serious adverse reactions such as rhabdomyolysis.