At what blood lipid levels should medication be started? Timing and classification of lipid-lowering drugs.
Under what circumstances should lipid-lowering drugs be actively used?
The pathogenic effect of dyslipidemia on cardiovascular and cerebrovascular diseases is certain. The severity of the disease, the risk of future cardiovascular and cerebrovascular events, and the lipid level determine the target lipid levels and whether immediate drug treatment is necessary.
If lipid levels exceed the target value after 3-6 months of therapeutic lifestyle changes, drug treatment should be considered.
For individuals undergoing lipid-lowering therapy, even if the baseline LDL-C is within the target range, LDL-C should still be reduced by approximately 30%.
Statins are the first-line lipid-lowering drugs. Low- to medium-strength statins should be started initially, with dosage adjusted appropriately based on the patient's lipid-lowering efficacy and tolerance, or combined with other lipid-lowering drugs.
In addition to active intervention for LDL-C, when serum TG ≥ 1.7 mmol/L (150 mg/dL), non-pharmacological interventions should be used first. If TG levels are only mildly to moderately elevated [2.3–5.6 mmol/L (200–500 mg/dL)], statins combined with fibrates or cod liver oil preparations can be considered. For patients with severe hypertriglyceridemia, i.e., fasting TG > 5.7 mmol/L (500 mg/dL), fibrates, cod liver oil preparations, or niacin should be used first.
What are the main types of lipid-lowering drugs?
Clinically, there are many types of lipid-lowering drugs, which can be broadly divided into drugs that primarily lower cholesterol and drugs that primarily lower TG. Most lipid-lowering drugs can lower both cholesterol and TG simultaneously. For severe hyperlipidemia, multiple lipid-lowering drugs are often required in combination to achieve the desired effect.
Cholesterol-lowering drugs include statins, ezetimibe, probucol, bile acid sequestrants, lipoprotein esters, and eicosanol, etc. Currently, the statin drugs available in China include lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, rosuvastatin, and pitavastatin.
Drugs that lower triglycerides (TG) mainly include fibrates, niacin, and high-purity fish oil preparations.
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