“I have high blood lipids, and I found online that it means I’m at risk of a heart attack soon. Is that true, doctor?”

“I didn’t see any upward arrows indicating high blood lipid levels on the test report, doctor. Why did you prescribe lipid-lowering drugs?”

The information you find online may not be reliable. So, let’s discuss dyslipidemia, which refers to an abnormal amount of lipids in the blood.

Dyslipidemia is commonly associated with atherosclerotic cardiovascular diseases (ASCVD), which include coronary heart diseases (such as myocardial infarction and angina) and are among the causes of stroke and peripheral vascular diseases.

ASCVD is the leading cause of death among residents in China, accounting for over 40% of all deaths.

 

What Do the Indicators in a Blood Lipid Testing Report Mean?

A blood lipid test report typically includes indicators for total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C).

Total cholesterol represents the sum of cholesterol in all lipoproteins in the blood.

Triglycerides are an important component of blood lipids, primarily providing energy.

LDL-C is a pathogenic risk factor for ASCVD, making it the primary target for lipid regulation. The level of HDL-C is negatively correlated with the risk of ASCVD.

Apolipoprotein A1 indicates the level of high-density lipoprotein (HDL) particles.

Lipoprotein B indicates the level of low-density lipoprotein (LDL) particles.

Lipoprotein (a) is a risk factor for ASCVD and calcific aortic stenosis.

 

Who needs Lipid Screening?

Adults under 40 should undergo lipid screening every 2 to 5 years to check for total cholesterol, triglycerides, LDL-C, and HDL-C in the blood.

Adults over 40 should have lipid screening at least once a year.

The frequency of lipid screening should be increased if any of the following conditions apply: a history of ASCVD; multiple ASCVD risk factors (such as hypertension, diabetes, obesity, or smoking); a family history of early-onset ASCVD (first-degree relatives diagnosed before age 55 for men or age 65 for women); familial hyperlipidemia; or the presence of xanthomas or thickening of the Achilles tendon.

 

What Should Be considered Before Lipid Screening?

Maintain your usual diet and stable weight for 2 weeks prior to lipid screening; avoid vigorous exercise within 24 hours before the screening; and fast for 8 to 12 hours the night before the test.

 

 

Does the Absence of Arrows on the Blood Lipid Test Report Indicate Normal Lipid Levels?

The doctor will conduct a comprehensive assessment that considers factors such as the presence of ASCVD, diabetes, hypertension, chronic kidney diseases, family medical history, and whether the patient smokes.

For example, the LDL level for patients with diabetes and ASCVD should be less than 1.4 mmol/L, while for patients aged 40 and over without ASCVD, it should be less than 1.8 mmol/L.

Therefore, even if your blood lipid test report indicates that your lipid levels fall within the reference range and there are no arrows suggesting elevated levels, the doctor may still prescribe lipid-lowering treatment for you.

 

How to Treat Dyslipidemia?

A healthy lifestyle is the foundation of dyslipidemia treatment, which includes a balanced diet, moderate exercise, weight control, smoking cessation, and limiting alcohol consumption.

A balanced diet plays a significant role in controlling blood lipid level. First, limit fat intake to 20-25 grams per day, replacing animal fats and palm oil, which contain saturated fatty acids, with plant oils. Second, increase your intake of vegetables, fruits, whole grains, dietary fiber, and fish.

If you do not have ASCVD, it is recommended to control your blood lipid levels through lifestyle adjustments. If your blood lipid levels remain abnormal after 3 months, lipid-lowering medications may be necessary. LDL-C level is the primary indicator for initiating lipid-lowering treatment

Elevated triglyceride levels in the blood are often a result of an unhealthy lifestyle. Therefore, exercise, dietary control, and strict limitation of alcohol consumption are effective in lowering triglyceride levels. Patients with elevated triglyceride levels should strictly limit alcohol intake.

If triglyceride levels are significantly elevated (≥5.6 mmol/L), there is an increased risk of pancreatitis. After excluding secondary causes of elevated triglyceride levels, such as hypothyroidism and nephrotic syndrome, medication treatment may still be necessary.

 

 

How to implement Lipid-lowering Treatment?

Medication should be continued after achieving the target level LDL-C. Recheck blood lipid levels, liver enzymes, and creatine kinase 4 to 6 weeks after starting treatment. If treatment goals are met without adverse reactions, recheck these items every 3 to 6 months.

 

 

Does a High Lipid Level indicate an Immediate Risk of Myocardial Infarction?

For every 1 mmol/L reduction in LDL-C, the risk of major cardiovascular events decreases by 21%, the risk of cardiovascular death by 13%, and the risk of stroke by 21% in diabetic patients. Therefore, there is no need to be overly concerned about dyslipidemia. With proper treatment, the risk of myocardial infarction can be significantly reduced.

 

Expert

Li Fangping

Leader and Director of the Endocrinology Department, the Seventh Affiliated Hospital of Sun Yat-sen University

Chief Physician, Postdoctoral Co-supervisor, Master’s Supervisor

 

Medical Expertise:

Diagnosis and treatment of diabetes, dyslipidemia, gout, hyperuricemia, thyroid diseases, pituitary diseases, adrenal gland diseases, gonadal diseases, and other endocrine and metabolic diseases. Dr. Li is especially specialized in the reversal treatment of type 2 diabetes, the diagnosis and treatment of abnormal pubertal development, female hyperandrogenism, and other rare endocrine diseases.

 

 

 

References:

1. Expert Consensus on the Lipid Management of Diabetic Patients (Version 2024)

2. Chinese Guidelines for Lipid Management (Primary Care Version 2024)

 

 

 

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