“This is the key to treating dyslipidemia in diabetic patients”

[헬스코리아뉴스 / 임해리] Ms. Park (female in her 50s), who lives in Gangdong-gu, made a health care plan for the new year and received a health checkup. Total cholesterol was 222, triglyceride was 77, low-density (LDL) cholesterol was 148, and high-density (HDL) cholesterol was 152. The result was ‘follow-up of dyslipidemia’. The word dyslipidemia was unfamiliar to Park, who has been suffering from menopausal symptoms as a diabetic for 10 years. ‘Should I lose weight? Should I take more medicine? Where can I get an explanation?’ I also searched the internet for various thoughts. Kangdong Kyung Hee University Hospital Endocrinology and Metabolism Professor Hwang Yoo-cheol asked what kind of disease dyslipidemia is. [편집자 글]

Professor Hwang Yoo-cheol of the Department of Endocrinology and Metabolism at Kyunghee University Hospital in Gangdong explains dyslipidemia. [헬스코리아뉴스 D/B]

‘Dyslipidemia’, which is too much or too little fat in the blood

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 in modern people, in the order of diabetes > blood pressure > obesity.

According to the ‘Korean Society of Lipid Arteriosclerosis Fact Sheet 2022’ data, the prevalence of dyslipidemia in adults over the age of 20 is regarding 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 25kg/m2 or more in the co-morbidity of chronic diseases called modern diseases such as diabetes, hypertension, and obesity. More than half of people with dyslipidemia are physically inactive, and 72% of men and 32% of women are known to drink alcohol.

Prevalence of dyslipidemia according to obesity, diabetes, and hypertension [자료=한국지질동맥경화학회 이상지질혈증 진료지침서 5판 발췌]

The most important comorbidity among them is diabetes. Diabetes itself causes various problems in the blood vessels. High blood glucose causes problems in several coronary arteries at once, and often recurs even following treatment. The survival rate is also disadvantageous compared to non-diabetics. Diabetes aggravates dyslipidemia by increasing levels of triglycerides and low-density (LDL) cholesterol and decreasing high-density (HDL) cholesterol.

“Diabetes patients need to 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. This is 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. This is why diabetic patients should treat and manage dyslipidemia more actively.

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 said, “Drug treatment is important to lower low-density (LDL) cholesterol levels, which is the main goal of dyslipidemia management in diabetic patients. ”he explained.

“The goal of drug treatment varies depending on the 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 the patient 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, the treatment time will vary depending on the patient’s age, gender, past cardiovascular disease, and current smoking. Professor Hwang said, “With the same lipid level, diabetic patients have a much higher risk of developing cardiovascular disease compared to non-diabetic patients,” and “therefore, treatment should be done earlier, more aggressively, and with lower lipid targets.” he emphasized.

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. Understandably, reaching and maintaining target levels is not easy for diabetics. 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.

Professor Hwang Yoo-cheol repeatedly emphasized, “Because the benefits of taking medication to prevent cardiovascular disease are obvious and greatly exceed the risk of loss depending on the side effects of the medication, it is always good to use medication 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 Yuchul Hwang said, “Management of dyslipidemia and hyperlipidemia in diabetic patients is a very important part not only in the quality of life, but also in the prevention and management of future complications. should be done,” he requested.

◆Dietary therapy recommendations (excerpts from the 5th edition of the dyslipidemia treatment guidelines of the Korean Society for Lipid and Arteriosclerosis)

1. It is recommended to consume enough energy to maintain an appropriate weight.

2. Keep your total fat intake within 30% of your energy intake.

3. Saturated fatty acid intake within 7% of energy intake

4. Substitute unsaturated fat intake to reduce saturated fat intake

5. Avoid eating trans fatty acids

6. In case of hypercholesterolemia (hyperlipidemia), reduce cholesterol intake

7. Total carbohydrate intake within 65% / total sugar intake within 10-20%

8. Dietary fiber intake is 25g or more per day

9. Limit alcohol to 1-2 drinks per day/preferably avoid alcohol

10. It is recommended to eat a diet rich in whole grains and other grains, vegetables, legumes, and fish.

– Intake of whole grains and mixed grains as staple food

– Eat enough vegetables

– Intake of meat and fish (reduce intake of red meat and processed meat)

– Eating the right amount of fresh fruit

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