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CARDIOLOGY

How to understand the blood lipid results of patients with coronary heart disease?

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Expert introduction:
Liu Ling Central South University Xiangya Second Hospital, Cardiology, Chief Physician, Professor, Master/Ph.D. Supervisor.Deputy Director of the Institute of Atherosclerosis, Central South University, deputy director of the Department of Cardiology, Xiangya Second Hospital.Mainly in the study of blood lipids and atherosclerosis, good at coronary heart disease, hypertension, heart failure, arrhythmia, dyslipidemia diagnosis and treatment.Published more than 60 research papers, of which more than 30 were published in international journals.He is the editor-in-chief of the academic monograph; he has edited 6 academic monographs.Hosted 4 national natural science funds.In 2007, he was selected into the “New Century Excellent Talents Program” of the Ministry of Education.In 2009, he was granted a grant from the China Scholarship Council to study abroad.In 2010, he won the “Hunan Provincial Outstanding Youth Fund”.He has obtained 10 provincial and ministerial level scientific and technological achievements.In 2009, he was awarded the second prize of the “Medical Achievement Award” of Central South University as the first finisher.Coronary atherosclerotic heart disease is a coronary artery atherosclerotic lesion that causes stenosis or obstruction of the vascular lumen, causing heart disease caused by myocardial ischemia, hypoxia or necrosis, often referred to as “coronary heart disease.”The coronary artery is the artery that is responsible for supplying blood to the heart. Whether the coronary artery is patency will affect the normal function of the heart.Coronary heart disease has a variety of manifestations, including myocardial infarction, angina pectoris, and even heart failure or sudden death.Once this happens, patients with coronary heart disease require active, standardized medications, and if necessary, coronary stenting or coronary artery bypass grafting.The basis of coronary heart disease is atherosclerosis.The formation of atherosclerosis is a long-term and chronic process that can occur during childhood and adolescence. Initially, only very slight abnormalities of the vessel wall occur, and early blood supply abnormalities are not caused.The main cause of atherosclerosis is the accumulation of lipids in the blood into the blood vessel wall, causing chronic vascular stenosis or obstruction; sometimes the diseased atherosclerotic lesions suddenly rupture, localized rapid thrombosis, and may also lead to blood vessels.Acute stenosis or obstruction of the lumen.However, if there are risk factors such as hyperlipidemia, smoking, obesity, and diabetes, atherosclerosis will progress very rapidly, making the age of onset of coronary heart disease much earlier.Cholesterol is the blood lipid component most closely related to atherosclerosis in the blood.Cholesterol lowering is the main measure against the formation of atherosclerosis.The main oral lipid-lowering drugs for patients with coronary heart disease are statins, including rosuvastatin, atorvastatin, simvastatin, pravastatin, lovastatin, red yeast extract (eg, Xuezhikang).A series of cholesterol-lowering drugs.Therefore, patients with coronary heart disease must adhere to lipid-lowering drugs and regularly check blood lipids, whether or not they undergo coronary artery bypass grafting or stent implantation. This will prevent the recurrence of coronary heart disease.As long as the patient does not have serious adverse reactions, he should insist on taking statins for a long time or even for life.As a doctor, you must be able to understand the patient’s blood lipid test list.1. What is the most important test item on the blood lipid test list?The basic test items on the blood lipid test list are total cholesterol (abbreviation: TC), low-density lipoprotein-cholesterol (abbreviation: LDL-C), high-density lipoprotein-cholesterol (abbreviation: HDL-C), glycerolThere are four esters (English abbreviation: TG).Among the four indicators, the key concern is low-density lipoprotein-cholesterol.2. How long should patients with coronary heart disease take statins to test for blood lipids?Patients with coronary heart disease should start taking statins after the first onset of illness. After 4 to 6 weeks after taking the drug, blood lipids can be reviewed to observe the efficacy of statins.In general, patients with coronary heart disease should re-examine blood lipids at the end of the third month of the initial onset of statin therapy.The low-density lipoprotein-cholesterol at this time should be controlled below the cardiovascular target’s intended target.3. What is the target of low-density lipoprotein-cholesterol in patients with coronary heart disease?Patients with coronary heart disease should not easily judge whether their LDL-cholesterol has reached the standard based on the range of reference values ​​on the test sheet.According to the recommendation of the 2016 Chinese Adult Diabetes Prevention and Treatment Guidelines (Revised Edition), the target of low-density lipoprotein-cholesterol in patients with coronary heart disease should generally be <1.8mmol/L.For example, if a patient with coronary heart disease has a basic low-density lipoprotein-cholesterol of 2.3 mmol/L, then this patient should reduce LDL-cholesterol from 2.3 mmol/L to less than 1.8 mmol/L within three months..The latest European guidelines for 2019 require a reduction in patients' LDL-cholesterol levels by at least 50% and a requirement to fall to <1.4mmol/L.4. If the patient's basal density lipoprotein-cholesterol level is too high, what is the target?According to the recommendation of the 2016 Chinese Adult Diabetes Prevention and Treatment Guidelines (Revised Edition), if the low-density lipoprotein-cholesterol before the onset of coronary heart disease is particularly high, it is difficult to drop to <1.8mmol/L, then you should take statin three.After the month, the reviewed low-density lipoprotein-cholesterol was reduced to 50% or more of the baseline value.For example, a patient with coronary heart disease has a basal low-density lipoprotein-cholesterol value of 4.50 mmol/L, and the patient subsequently started treatment with moderate-intensity statins for "coronary heart disease, acute myocardial infarction."Because of the high level of 4.50mmol/L, it is difficult to reduce the medium-strength statin to <1.8mmol/L.Then, the patient's low-density lipoprotein-cholesterol should fall below 4.50 × 0.5 = 2.25mmol / L in the three months after the onset, and the decrease is at least half of 4.50mmol / L.However, the high baseline value of low-density lipoprotein-cholesterol levels also indicates the possibility of familial hypercholesterolemia in this coronary heart disease patient.Once coronary heart disease is determined to be associated with familial hypercholesterolemia, the patient's LDL-cholesterol levels are more strictly controlled.In this case, the latest European guidelines not only require a reduction in LDL-cholesterol levels by at least 50%, but also a requirement to fall to <1.4 mmol/L.5. If the patient's basal density lipoprotein-cholesterol level is already below 1.8mmol/L, what is the target?According to the recommendation of the 2016 Chinese Adult Diabetes Prevention and Treatment Guidelines (Revised Edition), if the low-density lipoprotein-cholesterol before the onset of coronary heart disease is less than 1.8mmol/L, then the review should be made after three months of taking the statin.Density lipoprotein-cholesterol drops to 30% or more of the base value.For example, a patient with coronary heart disease has a basal low-density lipoprotein-cholesterol value of 1.50 mmol/L, and the patient subsequently started statin therapy for "coronary heart disease, acute myocardial infarction."Then, the patient's low-density lipoprotein-cholesterol should be reduced by 30% within three months of the onset, that is, the reduction of 0.45mmol/L or more, which is reduced to 1.50×0.7=1.05mmol/L or less.Target target.The latest European guidelines for 2019 require a reduction in patients' LDL-cholesterol levels by at least 50% and a requirement to fall to <1.4mmol/L.6. How to determine the basic low-density lipoprotein-cholesterol level in patients with coronary heart disease?If the patient is hospitalized urgently because of angina, the low-density lipoprotein-cholesterol value of the patient after admission can be used as a baseline value.The target of low density lipoprotein-cholesterol can be determined based on the base value.However, if the patient is hospitalized for acute myocardial infarction because of severe chest pain, the low-density lipoprotein-cholesterol level of the patient's blood test within 24 hours after the onset of acute myocardial infarction can be used as the baseline value; once more than 24 hours, the test is performed.The low-density lipoprotein-cholesterol level will be stress-induced due to acute myocardial infarction and therefore cannot represent the low-density lipoprotein-cholesterol base value in patients with coronary heart disease.At this time, the patient should look for the low-density lipoprotein-cholesterol level in the medical report before the onset of acute myocardial infarction as its basal value.For example, the patient was admitted to the hospital at 9 am on the same day because of "sudden severe chest pain for 6 hours."At 7 o'clock the next morning, blood was taken for blood lipid test, and the low-density lipoprotein-cholesterol level was 2.30 mml/L.According to the patient's sudden chest pain for 6 hours, the time point of the patient's acute myocardial infarction can be calculated at 3 am on the day of the onset.The time point at 7 o'clock in the morning of the next morning has exceeded the 24 hours of onset.If the patient has a blood test report of blood lipids two months before the onset, when the low-density lipoprotein-cholesterol level is 4.50 mml/L, then the patient's basal low-density lipoprotein-cholesterol level should be 4.50 mml/L instead of2.30mml/L.7. Is the low-density lipoprotein-cholesterol target in patients with coronary heart disease unchanged?The target of low-density lipoprotein-cholesterol in patients with coronary heart disease is not constant.Maintain low-density lipoprotein-cholesterol levels if the patient reaches a low-density lipoprotein-cholesterol target 3 months after the initiation of statin therapy and the condition is stable without recurrence of events such as acute myocardial infarction or unstable anginaIt will be fine.However, if the patient reaches the low-density lipoprotein-cholesterol target determined after the initial onset, an ischemic event such as acute myocardial infarction or unstable angina occurs, even if an ischemic event occurs in low-density lipoprotein-Cholesterol levels have been <1.8mmol/L, and new, lower LDL-cholesterol targets should still be redefined.For example, according to the 2016 Chinese Adult Diabetes Prevention and Treatment Guidelines (Revised Edition), the patient's next stage of low-density lipoprotein-cholesterol levels will be reduced by at least 30%.If patients have recurrent coronary heart disease events within two years, the latest European guidelines have stricter control of LDL-cholesterol levels and even require low-density lipoprotein-cholesterol levels to fall to <1.0 mmol/L.8. Does the cholesterol-lowering program in patients with coronary heart disease change after statin activation?In order to achieve the goal of low-density lipoprotein-cholesterol, cholesterol-lowering drugs should be adjusted according to the regularly reviewed low-density lipoprotein-cholesterol levels.Patients with coronary heart disease can review their blood lipids for the first time after 4 to 6 weeks of starting statin therapy.If low-density lipoprotein-cholesterol levels are not met, ask your doctor if you need to increase the dose of statins, or use a combination of drugs that reduce intestinal cholesterol absorption.Cardiovascular specialists adjust the cholesterol-lowering regimen based on whether the patient's coronary heart disease is stable, the low-density lipoprotein-cholesterol levels reviewed, and the dose of statin that has been taken.Blood lipids can be reviewed again 4 to 6 weeks after the protocol adjustment.It is often desirable for patients to achieve low-density lipoprotein-cholesterol levels that are up to 3 months after initial cholesterol-lowering therapy.If the adjustment of oral medications still fails to meet the standard, it is likely that a third cholesterol-lowering drug will need to be added to the treatment plan..

9, coronary heart disease patients with blood lipids must be fasting?Patients with coronary heart disease usually test for blood lipids in a fasting state that requires at least 8 hours before blood draw.In other words, there should be no calorie intake for at least 8 hours before blood draw, and only a small amount of water.If patients with coronary heart disease plan to take blood tests at 7 am the next morning, then no more calories can be taken after 11 pm that evening.However, since people are in a state of eating most of the day, and children, the elderly, or diabetics often cannot tolerate long-term fasting, the European consensus suggests that clinical routines can be performed in a non-fasting state.Blood collection test blood lipids.Because patients with acute myocardial infarction may have a low-density lipoprotein-cholesterol stress-induced decline after 24 hours of onset, patients with acute myocardial infarction can immediately take blood tests for blood lipids once they are admitted to the hospital, and are not limited to having to test blood lipids in a fasting state..In addition, patients who receive stable cholesterol-lowering drugs can also be tested for non-fasting blood lipids.Although European countries have promoted non-fasting blood lipid testing, there is no expert consensus or guidance on non-fasting blood lipid testing in China.Therefore, patients with coronary heart disease in China usually take blood tests for blood lipids in a fasting state.In order to avoid hypoglycemia caused by not eating for a long time, patients can carry foods such as candy, cakes or sugary soy milk with them in order to replenish calories and sugar in time.

ouyangshaoxia

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