Cardiovascular disease comes to your door!Crack the Two Myths and Actively Control LDL Cholesterol
An old man in his 70s had a problem with high cholesterol levels, but he didn’t take it seriously because he had no obvious symptoms. He didn’t know the seriousness of the situation until he had a myocardial infarction and was rushed to the hospital to put in a heart stent.
low density cholesterol(LDL-C) exceeding the standard is an important risk factor for cardiovascular diseases. Director Xu Rongcheng of the Department of Cardiovascular Medicine at Yadong Memorial Hospital pointed out that patients who have already suffered myocardial infarction and stroke are at very high risk. It is recommended that low-density cholesterol (LDL-C) ) index is controlled below 55 mg/dL[1]。
In Taiwan, hyperlipidemia, high blood pressure and hyperglycemia are quite common problems, and the prevalence rate increases with age.According to the 2013-2016 National Nutrition and Health Status Change Survey, about 11.42% of people aged 20-39 have hyperlipidemia; about 28.72% of people aged 40-64 have hyperlipidemia; among people over 65 years old, About 31.96% had the problem of hyperlipidemia[2]。
Low-density cholesterol (LDL-C), also known as “bad cholesterol”, is the main cause of atherosclerosis. When the low-density cholesterol in the blood is too high, it is easy to deposit in the endothelium of blood vessels, gradually causing narrowing and blockage of blood vessels, leading to cardiovascular diseases.Dr. Xu Rongcheng said that among the top ten causes of death among Chinese people, cardiovascular disease ranks second[3]second only to cancer, is an extremely important health issue.
Health hazards related to hyperlipidemia, including coronary heart disease, stroke, etc. Dr. Xu Rongcheng explained that coronary heart disease is the stenosis and blockage of the coronary arteries supplying the heart muscle, resulting in hypoxia and even necrosis of the heart muscle, which may cause sudden cardiac death. Stenosis and blockage of blood vessels in the brain can lead to ischemic stroke, which may lead to disability and death in severe cases.
Cracking the myth, hyperlipidemia treatment can do so!
There are many factors that lead to excessive cholesterol, including genes, diet, lifestyle, etc. Therefore, to control cholesterol, we must also take a multi-pronged approach from diet, exercise, and drugs. Drug control and non-drug control are both important.
Dr. Xu Rongcheng said that clinically, the individual control target will be determined according to the risk of the patient. If the risk is low, the target value of low-density cholesterol (LDL-C) is 116 mg/dL; (LDL-C) target value is 100 mg/dL; if it is high risk, such as diabetes for more than 10 years or has other risk factors, the target value is 70 mg/dL; if it is very high risk, such as myocardial infarction or stroke patients Low-density cholesterol (LDL-C) goal of 55 mg/dL[1]。
Director Xu Rongcheng gave an example of a case of Mr. Li in his 40s. Because he had a myocardial infarction, he had to control his low-density cholesterol (LDL-C) within 55 mg/dL in order to truly reduce the occurrence of cardiovascular diseases. risk. Mr. Li is currently cooperating with the medical team to control low-density cholesterol with drugs combined with lifestyle adjustments. Not only has he successfully reached the target value, but he has also avoided myocardial infarction.
【Personalized LDL Cholesterol Control Target】
| Cardiovascular Disease Risk Classification | low density cholesterol Control target value |
| low risk | Less than 116 mg/dL |
| moderate risk | Less than 100 mg/dL |
| high risk # Combined with more than 10 years of diabetes history or other related risk factors |
Less than 70 mg/dL |
| very high risk #Have a history of myocardial infarction or stroke |
Less than 55 mg/dL |
“Many patients know that they need to control their low-density cholesterol (LDL-C), but they often stop taking the medicine after seeing the low-density cholesterol value in the blood test report drop.” Dr. Xu Rongcheng said, “Hyperlipidemia is a chronic disease. Once If you stop taking the medicine, the low-density cholesterol (LDL-C) in the blood will soon rise. But when the blood lipid exceeds the standard, there are usually no symptoms, and you must have a blood test to know. Suspending the medicine without authorization will lead to unstable blood cholesterol. Treatment The effect will be greatly reduced!”
The reason why a small number of patients discontinue their medication is that muscle soreness occurs after taking blood lipid-lowering drugs. Dr. Xu Rongcheng said that if relevant side effects occur, they should return to the clinic to discuss with the doctor to see if the medication needs to be adjusted. If the drug is stopped without authorization, it may cause fluctuations in the concentration of cholesterol in the blood, which will have a negative impact on the body.
Statins are common lipid-lowering drugs, which can reduce the amount of cholesterol synthesized in the liver, and can reduce low-density cholesterol (LDL-C) by 30% to 50%. However, sometimes patients experience muscle pain. Soreness, Intolerance Conditions[2].Dr. Xu Rongcheng said that there is also a cholesterol-lowering injection (PCSK9 inhibitor), which can be injected subcutaneously every 2 weeks, which can reduce LDL-C by 50% to 60%. Patients who take oral drugs but still cannot reach the target or are intolerant, reach the treatment goal[1]。
After the guidance of the medical team, the cholesterol-lowering injection can be used by the patient or family members at home. The needle will not be seen during the injection process, and it will help improve convenience.
Family members participate together to help blood lipids reach the standard
The elderly suffer from many chronic diseases and often use multiple drugs in combination. It is easy to forget to take medicine or take medicine repeatedly. If family members participate together, it is very helpful for patients. Dr. Xu Rongcheng said that we can assist in distributing medicine boxes, arranging the medicines that need to be taken every day and every meal, and often reminding me to take medicines.
Family members can help record the blood drawing report and return visit time, understand the control effect, and remind patients to return to visit for follow-up. In addition to medication, the elderly should be reminded to avoid high-fat diets and high-cholesterol foods. Dr. Xu Rongcheng said that encouraging patients to exercise regularly and develop a good lifestyle will help their health.
Active treatment to prevent recurrence of stroke and myocardial infarction
“Patients who have already suffered from myocardial infarction or stroke have a relatively high risk of relapse, and even a 5% to 10% chance of relapse in one year.” Dr. Xu Rongcheng said that patients need to be more actively controlled with drugs and do a good job in secondary prevention .
Blood pressure, blood lipids, blood sugar and other chronic diseases must be controlled up to standard. Dr. Xu Rongcheng emphasized that the use of antiplatelet drugs is also very important to prevent thrombosis. In addition to the most well-known aspirin, there are also antiplatelet drugs with different mechanisms. If you experience myocardial infarction and have a heart stent installed, sometimes you need to use two antiplatelet drugs, that is, “dual antibody therapy”[4]。
The doctor will comprehensively evaluate the patient’s condition and decide on the use of antiplatelet drugs. Please be sure to take the drugs according to the doctor’s instructions. If you have gastrointestinal discomfort or black stool[5]Be sure to return to the clinic as soon as possible and discuss it with the doctor in detail.
Reminders for the Chongyang Respect for the Aged Month
Excessive low-density cholesterol (LDL-C) is an important factor causing cardiovascular diseases. As people age, the prevalence rate increases. Since there are no obvious symptoms, it is easy to be ignored, resulting in narrowing and blockage of blood vessels. Dr. Xu Rongcheng reminded us that we need to cooperate with diet, exercise, and medicine to make blood lipids reach individual goals, so as to reduce the risk of cardiovascular diseases!
October is the Double Ninth Month of Respecting the Aged, and the public is urged to pay more attention to the eating habits of the elders at home, eat less trans fats, eat more original foods and fruits and vegetables, and continue to observe the status of chronic disease medication. Return to the clinic to discuss with the attending physician and change the appropriate treatment plan.
References
- 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS), European Heart Journal, Volume 41, Issue 1, 1 January 2020, Pages 111–188
- National Nutrition and Health Status Change Survey 2013-2016 Results Report P.5
- Statistics Department of the Ministry of Health and Welfare/Top Ten Causes of Death in China
- ACC/AHA Versus ESC Guidelines on Dual Antiplatelet Therapy: JACC Guideline Comparison
- Dual antiplatelet therapy for coronary artery disease
