Dyslipidemia and dyslipidemia
The so-called blood lipid refers to the fat in human plasma, including triglycerides (also known as neutral fat), cholesterol and free fatty acids. Because most of these fats are insoluble in water, most of them combine with protein in blood to produce lipoproteins.
Some of these lipoproteins, such as triglyceride (TG), total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C), will be harmful to human body if the index is too high. On the contrary, some indicators are high, which are beneficial to human body, while low ones are harmful, such as high-density lipoprotein cholesterol (HDL-C). Therefore, careful readers will find that many publications will simply call it "hyperglycemia", "hypertension" and "hyperviscosity" when they talk about abnormal blood sugar, blood pressure and blood viscosity, but they will not say "hyperlipidemia" or "hyperlipoproteinemia" when they talk about abnormal blood lipids. The scientific term should be "dyslipidemia".
Dyslipidemia does not mean that all indexes are high, but that triglycerides, total cholesterol, low-density lipoprotein are too high and high-density lipoprotein is too low. In other words, low is not low, high is not high.
Dyslipidemia often causes complications. It is related to hyperglycemia, hypertension and hyperviscosity, and it is not only the main risk factor threatening the health and life of diabetic patients; It can also cause atherosclerosis, which is the primary factor causing coronary heart disease and cerebrovascular accident. If dyslipidemia is accompanied by hypertension, obesity, hyperglycemia, hyperuricemia and hyperinsulinemia, it is called metabolic syndrome. In addition, high triglyceride is easy to accompany acute pancreatitis.
Reducing blood lipid and regulating blood lipid
When it comes to the treatment of dyslipidemia, just like the term "hyperlipidemia" is not used, we generally don't call the treatment of dyslipidemia "lipid lowering" but "lipid regulation". Lipid-regulating means lowering the elevated lipoprotein level that is harmful to the body, and gradually raising the lowered lipoprotein level that is beneficial to the body.
Diabetes and dyslipidemia
In life, many diabetic patients are often accompanied by dyslipidemia. Dyslipidemia is an important cause of diabetic complications; On the contrary, the blood sugar of patients with dyslipidemia is also easy to rise, even called diabetes. Therefore, it is very meaningful to talk to you about the relationship between diabetes and dyslipidemia.
Diabetes is not terrible. The key is to control diabetes. To control diabetes well, it is necessary to keep patients' blood sugar, blood pressure, blood lipid and blood viscosity at a basically normal level. So how should diabetics regulate fat?
As we all know, blood sugar is closely related to blood lipids. After blood sugar is lowered, the level of blood lipids (especially triglycerides) will drop significantly, so it is necessary to control blood sugar first and then adjust blood lipids.
Because part of blood lipid comes from diet, diabetics should eat a diet high in fiber and low in fat, such as vegetables and coarse grains, especially eat less animal oil rich in saturated fatty acids, as well as animal viscera rich in cholesterol and seafood such as fish eggs, crab roe and shrimp. Vegetable oil is not as harmful to the body as animal oil, and may have some benefits, but vegetable oil is not harmless after all, the more the better.
Exercise therapy is also beneficial to the control of dyslipidemia and obesity, which can increase the consumption of calories and blood lipids, thus reducing dyslipidemia.
In particular, smoking is the main risk factor of atherosclerosis, and diabetic patients must quit smoking. If diabetic patients still have abnormal blood lipids after taking these measures, they must take lipid-lowering drugs at the same time.
● Introduction to the author
Xiang Hongding, male, is currently the deputy director of endocrinology department of Peking Union Medical College Hospital, director of diabetes center of Peking Union Medical College Hospital and doctoral supervisor. He has won the Science and Technology Achievement Award of the Ministry of Health for three times. In recent years, * * * has published more than 60 papers and participated in 20 books. Among them, the popular science monograph "How to Treat 300 Cases of Diabetes" published by Peking Union Medical College Press won the Third China University Press Association Excellent Double-effect Book Award and the Fourth National Excellent Popular Science Works Award.
Is your blood lipid normal?
Professor Zhang Ping, Department of Endocrinology, Southwest Hospital Affiliated to the Third Military Medical University
For most patients with dyslipidemia, there are generally no conscious symptoms, so when people check diabetes, coronary heart disease and other diseases, they often find dyslipidemia. Because there are no conscious symptoms, even if patients find a single dyslipidemia, most of them will be ignored and regretted when angina pectoris or myocardial infarction occurs. Therefore, we recommend that healthy adults check their blood lipids every four years, and the following groups of people are the key detection targets:
(1) Patients with a family history of dyslipidemia (if their parents have dyslipidemia); (2) obese people; (3) High-risk groups, including coronary heart disease, diabetes and metabolic syndrome, hypertension and hyperuricemia.
Examiners can refer to the following data to determine whether their blood lipids are abnormal:
1. Serum total cholesterol
Normal: < 5.17mmol/L.
Slightly increased: 5.17 ~ 6.47 mmol/L.
Hypertonic: ≥ 6.47 mmol/L.
Severe hypertension: ≥ 7.76 mmol/L.
2. Serum triglycerides
Normal: < 2.3 mmol/L.
Rising edge: 2.3 ~ 4.5 mmol/L.
Hypertension: > 4.5 mmol/L.
3. Serum high density lipoprotein cholesterol (HDL-C)
Adult male:1.16 ~1.42 mmol/L.
Female:1.29 ~1.55 mmol/l.
4. Serum low density lipoprotein cholesterol (LDL-C)
Middle-aged and elderly people: 2.7 ~ 3.1mmol/L.
Normal person: < 3.36 mmol/L.
Mild hazard value: 3.36 ~ 4.1.4 mmol/L.
Hazard level: > 4. 14 mmol/L.
The above data are extracted from "National Clinical Laboratory Operating Procedures".
● Introduction to the author
Zhang Ping, female, deputy director, professor, doctoral and master tutor of endocrinology department of Southwest Hospital affiliated to the Third Military Medical University, and vice chairman of Chongqing Diabetes Professional Committee.
Medication and lipid regulation vary from person to person.
April 2003 issue of Family Medicine □ Sun Ming, Professor of Internal Medicine, Hunan Xiangya Hospital
Because there are different types of dyslipidemia, medication should be used according to different situations.
Drugs commonly used to treat dyslipidemia can be divided into two categories. A class of statins includes simvastatin (Shujiangzhi), pravastatin (pravastatin), lovastatin (lipid-lowering), fluvastatin (lescok) and atorvastatin (A Le). Statins should be mainly used for raising cholesterol. The other is called Bates, including Gefilozzi (Nuoheng) and Fenofibrate (Lipitor). If triglycerides mainly increase, fibrates should be selected. A Le can be used for patients with both elevated levels.
If economic conditions permit, even if the blood lipid is normal, we should insist on taking statins for a long time. Recently, a large-scale international study confirmed that long-term (up to several years) use of statins such as simvastatin can reduce serious cardiovascular and cerebrovascular complications such as stroke and myocardial infarction by 30% ~ 40%. Attention should be paid to myalgia when using statins. Because individuals can cause muscle dissolution and myalgia, they should stop taking medicine and see a doctor.
Both drugs can cause abnormal liver function, especially fibrates. Liver function should be checked regularly. The two drugs can't be taken at the same time, because it will lead to severe muscle dissolution and acute renal failure. People with impaired liver function should not take it.
It is worth noting that the efficacy and adverse reactions of different individuals to the same drug are quite different. Therefore, in general, blood lipids, liver and kidney functions and serum uric acid levels should be rechecked 1 ~ 3 months after taking the medicine. Those who take medicine all the year round can review it once every 3 to 6 months. At the same time, relevant follow-up observation should be carried out in order to adjust the dose or replace the drug in time. When the blood lipid drops to close to the target level, the dosage can be appropriately reduced.
● Introduction to the author
Sun Ming, male, professor of internal medicine and doctoral supervisor of Hunan Xiangya Hospital, enjoys the allowance of scientific and technical personnel with special contributions in the State Council. He has been a doctor for more than 40 years and is good at the diagnosis and treatment of cardiovascular diseases, nephropathy and rheumatism. He is currently the executive director of China Hypertension Alliance, the chairman of Cardiovascular Society of Hunan Branch of Chinese Medical Association, the executive director of Hunan Branch of Chinese Medical Association, the director of Hunan Cardiovascular Disease Prevention Office and a member of the National Cardiovascular Disease Prevention Group.
Two magic weapons for regulating blood lipid
April 2003 issue of Family Medicine □ Professor Zeng of Metabolic Disease Hospital of Tianjin Medical University
In recent 20 years, the number of patients with dyslipidemia in large and medium-sized cities in China has been increasing. This is because the prosperity of economy and the improvement of living standards make people consume too much energy, but it is not enough. Therefore, as long as we master the two magic weapons of reasonable diet and proper exercise, we can effectively prevent dyslipidemia.
Reasonable diet
Since ancient times, China has accumulated rich experience in diet research. As early as Huangdi Neijing, the multi-source nutrition theory of "five grains for nourishment, five fruits for help, five livestock for benefit and five vegetables for supplement" was put forward. Modern nutrition also puts forward seven nutrients-sugar, protein, fat, vitamins, inorganic salts, water and cellulose, which are indispensable substances to maintain normal life activities of the body.
Unit: kcal/kg body weight
Overweight or obese normal weight underweight or emaciated.
Static state 202530
Light manual labor 253035
Manual labor 303540
Heavy physical labor 354045
A reasonable diet requires that the types of nutrients contained in the diet should be complete, the quantity should be sufficient, and the proportion should be appropriate. The calories provided by nutrition should be balanced with the calories needed by the body.
A person's daily energy demand varies with gender, age, height, weight and activity. Generally speaking, the heat required for 1 person 1 day = standard weight (kg) × 1 kg body weight (kcal). Standard weight = height (cm)-105. If the actual weight exceeds 10% ~ 20% of the standard weight, it is overweight; More than 20% are obese. If the actual weight is less than 10% ~ 20% or more of the standard weight, it is underweight or emaciated (see the left table for the daily calorie requirement per kilogram of standard weight with different labor intensity).
Excessive calorie intake is not only the cause of dyslipidemia, but also the cause of hypertension, obesity, diabetes and other related diseases. However, if the long-term intake of calories is too small to reach the minimum calories to maintain the body, it is prone to hunger ketosis, which will lead to chronic malnutrition over time.
Among the three nutrients that provide calories for human body, sugar accounts for 55% ~ 60%, protein accounts for 15% ~ 20%, and fat accounts for 20% ~ 25%. Sugar includes starchy foods such as rice, noodles and potatoes. Excessive sugar intake will be converted into fat, leading to abnormal blood lipids, so it should be controlled. Foods rich in protein include aquatic products such as livestock and poultry meat, fish and shrimp, eggs, milk, beans and their products. Fatty foods include animal fat and vegetable oil. Especially the intake of butter, cream and fat should be controlled.
Cholesterol is a component of human cell membrane and plays an important role in maintaining normal metabolism. But long-term excessive intake will increase the total cholesterol. Egg yolk, animal viscera, fish and shrimp are rich in cholesterol. Besides cholesterol, eggs also contain high-quality protein, iron and vitamins. Eating an egg a day can provide high-quality protein and enough cholesterol.
Dietary fiber can inhibit the absorption of cholesterol and triglycerides in blood, and at the same time combine cholesterol with fatty acids and excrete them, thus reducing blood lipids. Cereals, soybeans and vegetables all contain dietary fiber. Cereals are also rich in vitamin B 1. Vegetables are low in calories and rich in minerals and vitamins, so they should be eaten more. Compared with vegetables, fruits also contain vitamins and minerals. However, it is not suitable to eat more because of its high calories, and fruits can't replace vegetables to meet nutritional needs. Auricularia auricula and seaweed contain no calories and are high-quality foods rich in dietary fiber that can easily cause satiety.
Besides, three meals a day should be reasonable. Have a full breakfast, have a good Chinese meal, and eat less at dinner. Three meals a day should be varied, chew slowly and maintain a standard weight. Reducing consumption does not mean reducing meals. When reducing meals, nutrients are used more effectively, which is more likely to lead to obesity and nutritional imbalance. So every meal should have staple food (rice, noodles, etc. Main course (rich in high-quality protein bean products, fish, shrimp, meat, eggs, etc.). ) and side dishes (vegetables). It is easy to meet the body's intake of different nutrients with a variety of foods every day, thus achieving a nutritional balance.
by oneself
Long-term regular exercise is the main way to consume calories, which can reduce plasma cholesterol and triglyceride levels, but we must master the amount and mode of exercise.
First of all, we should try to choose suitable, systemic, rhythmic and non-competitive sports, so that all parts of the body can be exercised, such as doing exercises, playing Tai Ji Chuan, jogging, walking for a long time and so on. Especially ballroom dancing, middle-aged and elderly disco or yangko.
Secondly, we must master the amount of exercise. Proper exercise can achieve the purpose of prevention, otherwise it will cause damage to the body and aggravate the condition. Exercise time should vary from person to person, and can be flexibly mastered according to exercise habits and lifestyle. Generally speaking, not less than 5 times a week, each time controlled in 30 ~ 40 minutes. It is better to exercise in the afternoon.
As for exercise intensity, pulse rate is generally used to estimate it. Pulse rate of moderate intensity exercise =(220- age) × (60% ~ 85%). For example, the exercise heart rate range of a 60-year-old person = (220-60) × (60% ~ 85%) = 96 ~136 beats/min. Generally, you can count your pulse immediately after exercise and measure your heart rate per minute. Then you can compare the formula to adjust your own exercise. According to this formula, it is more appropriate to exercise for about 30 minutes.
● Introduction to the author
Zeng, female, doctor, professor. Honorary Dean of Metabolic Disease Hospital of Tianjin Medical University, member of China Diabetes Committee of Integrated Traditional Chinese and Western Medicine, and chairman of Tianjin Diabetes Committee of Integrated Traditional Chinese and Western Medicine.
Regulating blood lipid-solving puzzles
Family medicine, April 2003
Q: How do diabetic patients with dyslipidemia choose drugs when regulating blood lipids? What is the optimal value of adjustment?
Professor Xiang Hongding: There are many kinds of lipid-lowering drugs on the market, which are mainly divided into the following categories: (1) triglyceride-lowering drugs, such as linoleic acid, γ-linoleic acid, deep-sea fish oil, doxycycline, etc. (2) Drugs that mainly reduce triglycerides, supplemented by cholesterol: such as nicotinic acid, inositol nicotinate, and fibrate lipid-regulating drugs. The last two words of the latter trade name are mostly called "fibrates", such as fenofibrate and bezafib, which have better curative effect; (3) Drugs that mainly reduce cholesterol, supplemented by triglycerides: The last three words of these drugs are mostly "atorvastatin", so they are also called statins, such as pravastatin and simvastatin; (4) Cholesterol-lowering drugs: such as cholestyramine and jiangdanning. Diabetic patients should use these drugs correctly under the guidance of doctors in order to achieve satisfactory lipid-lowering effect.
Dyslipidemia, like hypertension and hyperglycemia, not only needs treatment, but also must reach the standard, otherwise it is difficult to achieve satisfactory results. Specific standard values are as follows:
Treatment and standard value of blood lipid
Unit: mg/dl (mmol/l)
Ideal standard
triglyceride
cholesterol
low density lipoprotein
High density lipoprotein (HDL-C) >: 44 (1.1) > 36 (0.9)
Q: Who is prone to dyslipidemia?
Professor Xiang Hongding: Dyslipidemia is mainly caused by two factors, namely heredity and environment. Hereditarily, people with a family history of dyslipidemia are prone to dyslipidemia. From the environmental point of view, obese people and people who like to eat greasy and high-fat foods are prone to dyslipidemia. In addition, people who are high risk factors are prone to dyslipidemia, including patients with coronary heart disease, diabetes and metabolic syndrome, hypertension and hyperuricemia.
Q: Is obesity related to blood lipid levels?
Professor Zhang Ping: Fat synthesis is the material basis of obesity. If the daily intake of calories exceeds the energy required for consumption, except glycogen stored in liver and muscle, almost all of these calories are converted into fat and stored in fat banks all over the body, among which triglycerides are the main ones. There is no obesity without fat, so there is an inevitable relationship between obesity and blood lipid level.
Simple obesity (obesity not caused by other diseases) is often accompanied by mixed dyslipidemia. At the same time, some obese patients are often accompanied by endocrine and metabolic disorders, such as hyperinsulinemia, insulin resistance or other endocrine hormones, which leads to the increase of total cholesterol, triglycerides and free fatty acids, which in turn leads to abnormal blood lipids or uneven fat distribution.
In recent years, some people think that the muscle triglyceride content of type II diabetes is stronger than any related factors, and even suggest that diabetes should be changed to glycolipid disease. Therefore, obesity, diabetes and blood lipids are closely related, and any abnormality between them may lead to imbalance of lipid metabolism.
Q: What should I pay attention to before measuring blood lipids?
Professor Zhang Ping: Before measuring blood lipids, patients should: have an empty stomach; Eat a low-fat diet for 3 days or a normal diet for 3 days. Don't overeat and eat more greasy food.
Q: Are there any cheap and effective Chinese herbal medicines for regulating blood lipids?
Professor Sun Ming: There are many kinds of Chinese herbal medicines that have been proved to have different degrees of lipid-lowering effects, such as Polygonum multiflorum, Alisma orientale, hawthorn, auricularia auricula, rhubarb and so on. However, the efficacy and exact effect of these drugs have not been confirmed by large-scale clinical experiments, so they should only be used as auxiliary drugs.
Q: Can patients with dyslipidemia drink alcohol?
Professor Zeng: Patients with dyslipidemia should limit drinking. Moderate drinking (such as 100 ml red wine) can increase the content of high-density lipoprotein with anti-atherosclerosis effect in the blood, but excessive drinking can increase the triglyceride in the blood and decrease the content of high-density lipoprotein, thus promoting the development of atherosclerosis, so drinking should be restricted. But for people with liver dysfunction, alcohol should be banned.