China National Cholesterol Education Program Training Materials

Author: Hu Dayi
Publisher:
Publish Date: 2005-04-01
Features: Active lipid-lowering, effective prevention and treatment of coronary heart disease. Dyslipidemia generally refers to the levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides in the serum being higher than the normal range and/or the level of high-density lipoprotein cholesterol (HDL-C) being low. Dyslipidemia is also known as hyperlipidemia, primarily referring to the elevation of serum total cholesterol (LDL-C) levels and/or triglyceride levels. Epidemiological, basic, and clinical studies have all confirmed the close relationship between dyslipidemia and atherosclerotic diseases. This introduction covers how to follow dyslipidemia treatment guidelines and address some common issues encountered in clinical practice. Guiding clinical practice with treatment guidelines is a challenge faced by clinicians. When dealing with patient populations, we first need to determine those with dyslipidemia through lipid tests and comprehensively assess the risk of cardiovascular diseases through risk factor stratification to identify high-risk patients for cardiovascular diseases. Then, according to dyslipidemia treatment guidelines, determine the corresponding treatment goals and adopt effective treatments to achieve target lipid levels. For high-risk patients, intensive treatment is also required.
I. Determining Dyslipidemia and Its Types
For patients with existing coronary heart disease, cerebrovascular disease, or peripheral artery atherosclerosis; those with hypertension, diabetes, obesity, or smoking habits; those with a family history of early atherosclerosis; those with familial hyperlipidemia; or those with xanthomas or xanthelasmas, lipid tests must be conducted upon consultation. For men over 40 and postmenopausal women, lipid tests should also be considered. The lipid tests include total cholesterol (TC), triglycerides (TG), and HDL-C. LDL-C can be calculated using the Friedewald formula: LDL-C (mmol/L) = TC - HDL-C - TG/2.2 or LDL-C (mg/dL) = TC - HDL-C - TG/5. When TG > 400 mg/dL (4.5 mmol/L), LDL-C should be directly measured. Based on lipid levels, determine whether dyslipidemia exists and classify its type according to simple dyslipidemia categories: hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, or isolated low HDL-C.
II. Determining High-Risk Patients for Cardiovascular Diseases
For dyslipidemia patients, risk stratification should first be conducted according to China's dyslipidemia prevention and treatment recommendations and the guidelines for dyslipidemia prevention and treatment established by the Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program (NCEP). The stratification is based on the presence or absence of the following risk factors: ① Major risk factors for coronary heart disease other than LDL-C: smoking, hypertension (BP ≥ 140/90 mmHg or receiving antihypertensive treatment), low HDL-C.