[Welfare News]Ms. Park (female in her 50s) living in Gangdong-gu received a health checkup while making a health care plan for the new year.
Total cholesterol 222, triglyceride 77, low-density (LDL) cholesterol 148, high-density (HDL) cholesterol 152, and received the result of ‘follow-up of dyslipidemia’. Park has been suffering from menopausal symptoms as a diabetic for 10 years. The word dyslipidemia is unfamiliar. ‘Should I lose weight? Should I take more medicine? Where can I get an explanation?’ I am diligently searching for tens of thousands of worries.
Too much or too little fat in the blood, dyslipidemia
Dyslipidemia is a condition in which total cholesterol, low-density (LDL) cholesterol and triglycerides, which are bad cholesterol that causes arteriosclerosis, increase in the blood, or high-density (HDL) cholesterol, which is good cholesterol that prevents arteriosclerosis, is decreased. . Among these, hypercholesterolemia when low-density (LDL) cholesterol is high, hypertriglyceridemia when triglycerides are high, and dyslipidemia are combined to the case where the above-mentioned high-density (HDL) cholesterol is decreased. Dyslipidemia is a condition in which there is an excess of lipid components in the blood, and these lipid components accumulate on the walls of blood vessels and cause inflammation, which can cause cardiovascular diseases such as angina pectoris or myocardial infarction.
There are various causes such as gene mutation, obesity, and alcohol.
The causes are diverse, but they are largely divided into primary causes caused by specific gene mutations and secondary causes related to obesity, alcohol consumption, high carbohydrate and high-fat diets, thyroid, kidney, liver function abnormalities, and type 2 diabetes. In particular, hypertriglyceridemia is closely related to obesity, alcohol consumption, type 2 diabetes, and unhealthy eating patterns, which are problems in modern society. Low-density lipoprotein (HDL) cholesterol is known to be caused by genetic predisposition, obesity, and smoking.
Dyslipidemia refers to a total cholesterol level of 240 mg/dL, low-density (LDL) cholesterol of 160 mg/dL, triglyceride level of 200 mg/dL or more, and high-density (HDL) cholesterol of less than 40 mg/dL in men and 50 mg/dL in women. .
Dyslipidemia is the most common disease of modern people, in the order of “diabetes > blood pressure > obesity.”
According to the ‘Korean Society of Lipid and Arteriosclerosis Fact Sheet 2022’ data, the prevalence of dyslipidemia in adults aged 20 years and older was approximately 40%. In particular, dyslipidemia was found in 87% of diabetic patients, 72% of hypertension patients, and 53.7% of obese patients with a BMI of 25 kg/m2 or more in the co-morbidity of chronic diseases called modern diseases such as diabetes, hypertension, and obesity. More than half of dyslipidemia patients are physically inactive, and 72% of men and 32% of women are known to drink alcohol.
One of the most important comorbidities is diabetes. Diabetes itself causes various problems in the blood vessels. High blood glucose causes problems in several coronary arteries at once, often recurs even after treatment, and has a poor survival rate compared to non-diabetics. Diabetes also aggravates dyslipidemia by increasing levels of triglycerides and low-density (LDL) cholesterol and decreasing high-density (HDL) cholesterol.
Diabetes patients should be treated earlier, lower, and more aggressively
In the case of a diabetic patient, even if the level of low-density (LDL) cholesterol exceeds 100 mg / dL, it is diagnosed as dyslipidemia requiring treatment by a specialist, because low-density (LDL) cholesterol has a very close relationship with the occurrence of cardiovascular disease. Diabetic patients are more likely to develop atherosclerosis as very low density lipoprotein (VLDL) cholesterol increases even if the level of low-density (LDL) cholesterol is not high. Therefore, when diabetes is accompanied by problems of dyslipidemia, the possibility of cardiovascular disease increases. Therefore, in the case of diabetic patients, it is necessary to more actively cope with the treatment and management of dyslipidemia.
This dyslipidemia can be partially improved by diet therapy and exercise therapy, but there are limitations in many cases, so drug therapy is often required. Professor Hwang Yoo-cheol of the Department of Endocrinology and Metabolism at Kyunghee University Hospital at Gangdong said, “Drug treatment is important to lower low-density (LDL) cholesterol levels, which is the main goal of dyslipidemia management in diabetic patients. Reaching the target number with exercise and diet alone may have limitations,” he explained.
Drug treatment goals vary depending on underlying disease
Professor Yuchul Hwang said, “In the treatment of dyslipidemia, the target of lipids and the starting point of treatment change when other characteristics of patients are considered along with low-density (LDL) cholesterol, high-density (HDL) cholesterol, and triglyceride levels. For example, even if the same low-density (LDL) cholesterol is 130 mg/dL, it varies depending on the patient’s age, gender, past cardiovascular disease, and current smoking status. When the lipid level is the same, diabetic patients have a much higher risk of cardiovascular disease compared to non-diabetic people. So we need to treat earlier, more aggressively, with lower lipid targets.”
If a diabetic patient is accompanied by dyslipidemia, lifestyle correction and blood sugar control efforts must be accompanied to achieve the goal of dyslipidemia treatment. Of course, it is not easy for diabetics to reach and maintain their target levels. If diabetes and dyslipidemia are accompanied, drug treatment called ‘statin’ is basic. In some patients, there may be side effects such as elevated liver levels, muscle side effects, and increased blood sugar. However, in most cases, it is not severe enough to be a clinical problem.
Kangdong Kyung Hee University Hospital Endocrinology and Metabolism Professor Hwang Yoo-cheol emphasized, “Because the benefits of taking medications to prevent cardiovascular disease are obvious and greatly exceed the risk of loss depending on the side effects of the medications, it is recommended to use medications if necessary.” .
If you are a diabetic but do not have cardiovascular disease, you should control your high-density (HDL) cholesterol to less than 100 mg/dL. However, if you have cardiovascular disease, chronic kidney disease, hypertension, smoking, or coronary artery disease, or if you have a family history, it is recommended to adjust the level to less than 70 mg/dL.
Professor Hwang Yoo-chul of Kyunghee University Hospital at Gangdong said, “Management of dyslipidemia and hyperlipidemia in diabetic patients is a very important part not only for the current quality of life, but also for the prevention and management of future complications. We recommend that you conduct integrated management of blood sugar, blood pressure, lipids, lifestyle, etc. with a professional medical team.”