For high-risk groups, blood lipid management must meet standards

&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. The “three highs” or “four highs” usually referred to as high blood lipids are indispensable. Generally speaking, blood lipid indicators mainly include four items: cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Among them, the first three items increased or the fourth item decreased are abnormal blood lipid metabolism. Among them, elevated low-density lipoprotein cholesterol is the most certain risk factor for cardiovascular and cerebrovascular diseases, and it is a certain factor leading to atherosclerosis. Therefore, to control blood lipids, in most cases this indicator must be controlled first. This is especially true for patients with cardiovascular disease risk factors. The “Expert Consensus on the Clinical Pathway of Blood Lipid Management in Patients with Acute Coronary Syndrome (ACS)” pointed out that abnormal blood lipids in ACS patients, especially elevated low-density lipoprotein cholesterol (LDL-C), are key factors leading to the occurrence and development of cardiovascular events. For the management of blood lipids in ACS patients, existing guidelines consistently emphasize that LDL-C is still the main target of lipid-lowering intervention. Consensus recommends that the target value of LDL-C in patients with ACS combined with high-risk factors can be further reduced to &lt.1.4mmol/L (55mg/dl) on the basis of 1.8mmol/L (70mg/dl) and the LDL-C lipid-lowering rate is ≥ 50%, and for patients with recurrent vascular events (not necessarily the same as the first event) within two years and taking the maximum tolerated dose of statins, the lipid-lowering treatment goal can be considered as LDL-C&lt.1.0mmol/L (&lt.40mg/dl) . &nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. Therefore, lipid-lowering therapy or lipid therapy must have clear goals, stratify treatment according to risk factors, and achieve the best benefits. &nbsp.

Primary prevention of stroke

Li Na’s stroke, also known as “stroke” or “cerebrovascular accident”, is an acute cerebrovascular disease, a disease caused by damage to brain tissue due to the sudden rupture of blood vessels in the brain or the inability of blood to flow into the brain due to blocked blood vessels. Divided into ischemic and hemorrhagic stroke. So how should we prevent stroke? Let’s listen to Dr. Li Na from the Department of Kawabi Medicine! &nbsp. Lifestyle intervention 1. Quit smoking; 2. Weight loss; 3. Limit drinking; 4. Diversified diet: reduce sodium (≤6g/d), increase potassium (≥4.7g/d) intake, and eat less sugar And sweets; 5. Individualized exercise: healthy adults at least 3~4 times/week, at least 40min at a time, choose moderate or higher intensity exercise, preferably aerobic exercise. Main risk factors for prevention and control 1. Hypertension, systolic blood pressure &lt. 160 mmHg and diastolic blood pressure &lt. 100 mmHg without coronary heart disease, heart failure, stroke, peripheral atherosclerosis, kidney disease or diabetes. Lifestyle changes: up to 3 months of failure to reach the standard to start drug treatment, continuous and reasonable drug treatment; blood pressure <140/90mmHg with diabetes or kidney disease can be further reduced; patients aged ≥80 years without diabetes or chronic kidney disease The pressure goal is: systolic blood pressure < 150mmHg and diastolic blood pressure &lt. 90mmHg. 2. Diabetes is regularly tested; after changing lifestyles, the effect is not good after 2~3 months, add drugs; strictly control blood sugar and blood pressure, and combine statin lipid-lowering drugs. 3. Atrial fibrillation (1) Non-valvular atrial fibrillation: CHA2DS2-VASc score, except for female gender score. Score ≥2, anticoagulation treatment is recommended; score=1, oral anticoagulation can be considered based on benefit and risk measurement; score=0, no anticoagulation and antiplatelet drugs are used. (2) Valvular disease complicated with atrial fibrillation, no need to score the risk factors of embolism. Choice of anticoagulant drugs (1) Non-valvular atrial fibrillation: Warfarin or NOACs can be preferred, NOACs with valvular disease and atrial fibrillation are preferred; (2) Valvular disease with atrial fibrillation: Warfarin. It should be noted that the dynamic evaluation of the patient's bleeding risk throughout the process to determine the corresponding treatment plan; does not advocate the use of anti-platelet agents as atrial fibrillation stroke prevention; is not suitable for long-term anticoagulation therapy can consider the left atrial appendage occlusion. 4. Periodic detection of dyslipidemia: With hypertension, diabetes, and cardiovascular disease, regardless of the baseline LDL-C level, it advocates lifestyle changes and sustained, reasonable drug treatment. (1) Very high-risk: LDL-C < 1.8 mmol/L; (2) High-risk: LDL-C & lt; 2.6 mmol/L; (3) Medium-risk and low-risk: LDL-C < 3.4 mmol/L; (4) Those with a high LDL-C baseline value and failing to meet the standard: LDL-C should be at least 50% lower than the baseline value; (5) Very high-risk individuals with the LDL-C baseline value within the target value: LDL-C should be at least reduced 30%. 5. Take aspirin and statins daily in asymptomatic carotid stenosis; patients with high-risk stroke should consider carotid endarterectomy. 6. Other risk factors: hyperhomocysteinemia, postmenopausal hormone therapy, oral contraceptives, sleep disordered breathing, hypercoagulability, inflammation and infection, migraine, genetic factors. Aspirin is used for the primary prevention of stroke, but it is not recommended for the following populations: 1. People with low risk of cerebrovascular disease; 2. Diabetes without evidence of other clear cerebrovascular disease risk factors; 3. Diabetes with asymptomatic peripheral arterial Diseases and the following populations are suitable for aspirin: 1. Individuals with a 10-year cardiovascular and cerebrovascular event risk of 6%-10%; 2. Individuals with a 10-year cardiovascular and cerebrovascular event risk> 10%; 3. Patients with chronic kidney disease Ball filtration rate &lt.45m|.min-1-1.73m-2, excluding patients with severe kidney disease (stage 4 or 5, glomerular filtration rate&lt.30ml.min-1.1.73m-2) of stroke Risk factors Risk factors for stroke 1, unchangeable risk factors: including age, gender, low birth weight, ethnicity, genetic factors and so on. These factors are generally considered to be uncontrollable or unchangeable risk factors. 2. Risk factors with sufficient evidence and control: including hypertension, smoking, diabetes, atrial fibrillation, other heart

Is high cholesterol actually “good”?

Everyone knows that the cholesterol in our body has “good” cholesterol and “bad” cholesterol. Among them, low-density lipoprotein (LDL-C) is closely related to cardiovascular and cerebrovascular diseases. The most important use of statins or ezetimibe is It is to reduce LDL-C; high-density lipoprotein (HDL-C) is “good” cholesterol, and its higher level can reduce the risk of cardiovascular and cerebrovascular diseases. So, is there any way to raise these “good” cholesterol? &nbsp.1. Get active&nbsp. “Life is exercise”, no matter when, maintaining physical exercise is good for cardiovascular and cerebrovascular diseases, and also helps to improve the level of HDL; &nbsp.2. Lose weight &nbsp. If you are in Being overweight or obese, reducing body weight can increase HDL levels and also help reduce “bad” cholesterol levels; &nbsp.&nbsp.3. Choosing better fats and fats is a type we must consume every day. The healthier way is to choose unsaturated fat or polyunsaturated fat. For example, by eating nuts and certain fish (such as salmon or tuna) to consume these better fats. &nbsp. 4. Stop smoking. Start quitting smoking from now on, this habit can help improve your HDL level.