Dyslipidemia is always silent, but it will unconsciously "paste" one blood vessel after another

Dyslipidemia is always silent, but it will unconsciously "paste" one blood vessel

In a physical examination report, the abnormality of blood lipids mainly depends on four indicators: triglycerides, total cholesterol, HDL cholesterol and LDL cholesterol

Recently, the Japanese Atherosclerosis Society updated the "abnormal blood lipid standard" and included "postprandial triglyceride level" in the diagnostic indicators

What does this change mean? "Life Times" (search for "LT0385" in WeChat can be followed) invites authoritative experts to interpret the new standard and summarize how to choose

Zhang Haicheng, chief physician of the Department of Cardiology, Peking University People's Hospital

This article is written by | Life Times reporter Dani Lee

Japan Updates "Diagnostic Criteria for Dyslipidemia"

For the first time in five years, the Japanese Atherosclerosis Society revised the "Guidelines for the Prevention of Atherosclerotic Diseases", adding that "in a non-fasting state, triglyceride (TG) levels greater than 175 mg/dL (1.

For the above revision, Zhang Haicheng said that it is reasonable for Japan to include non-fasting triglyceride indicators in diagnostic

At present, when testing blood lipids in China's hospitals or physical examination centers, it is still routine to require the subject to test fasting lipids at least 8 hours before intravenous blood collection, that is, to detect fasting blood lipids, if the triglyceride level is greater than 1.

"However, the results of this fasting test do not reflect the real situation of the total blood lipid load of the human body, and not the fasting (that is, after the meal) is the real state

If the strict requirements of "fasting" are strictly followed after at least 8 hours from the last food intake, "fasting" actually refers specifically to the state

What problems may I encounter when collecting blood on an empty stomach?

In clinical operations, there are many inconveniences in collecting blood on an empty stomach

Increase the time spent on medical attention

Patients often have to make appointments because they do not have an empty stomach for the first visit, and miss work and time, affecting their original life and work arrangements; Some people even simply abandon the examination, resulting in a missed diagnosis

Special populations are at risk

Mandatory fasting lipid testing forces elderly and frail individuals and special patients to endure starvation, creating a potential risk

Increase the load on the relevant departments

Concentrated fasting blood draw in the morning makes the relevant departments and staff overloaded during peak hours, which may lead to doctor-patient conflicts

What is the significance of non-fasting lipid testing?

Not only in Japan, as early as 6 years ago, the expert consensus (referred to as the "European Expert Consensus") jointly published by the European Society of Atherosclerosis (EAS) and the European Union of Clinical Chemistry and Laboratory Medicine (EFLM) proposed that in addition to the need for fasting in specific cases, the routine use of non-fasting lipid testing

In addition, the Copenhagen City Heart Study in Denmark confirmed that elevated non-fasting triglycerides are independent risk factors
for myocardial infarction, ischemic heart disease, ischemic stroke, and all-cause death.

A larger Copenhagen general population study (92,285 participants) also confirmed that elevated non-fasting triglyceride levels are strongly associated with the risk of ischemic heart disease, myocardial infarction, and death, and that changes in blood lipids 1 to 6 hours post-meal are not clinically
different.

Zhang Haicheng said that these consensuses and studies will challenge
the traditional concept of blood lipid testing in China.

Last year, domestic scholars also observed the changes in blood lipids between overweight people and controls within 4 hours after a daily breakfast, and found that the non-fasting incision point corresponding to the fasting triglyceride 1.
7 mmol/L was 2.
02 mmol/L, which was very close to the 2 mmol/L
recommended by the European expert consensus in 2016.

At present, there is no recognized non-fasting abnormal classification standard in
China.
Some domestic experts in the clinic, will refer to the European expert consensus and combined with the actual situation of patients, in the blood lipid test does not force fasting
.

For example, patients who need to be assessed for cardiovascular disease risk, patients admitted to hospital for acute myocardial infarction, diabetics, children, the elderly, patients receiving stable drug therapy, and patients with familial hyperlipidemia can use non-fasting blood collection to reduce unnecessary medical troubles
.

Fasting VS non-fasting test, how to choose?

At present, the criteria for defining dyslipidemia in the domestic non-fasting state are different from the current revision in Japan, which is that the triglyceride level is greater than 2 mmol/L (177 mg/dL).

This is because most of the cooking habits of the Chinese people are fried, fried, fried, and the oil is also put more, and the definition of the triglyceride level value is slightly higher
.

However, when the non-fasting triglyceride value is greater than 3.
95 mmol/L, doctors will ask about the diet in recent days, because triglyceride levels are easily affected by the fat content in short-term foods and are given the option to measure triglyceride levels
in the fasting state if necessary.

Zhang Haicheng said that the reason why there is no official document to revise the criteria for dyslipidemia in China is because this cognitive change requires a large number of more convincing medical data as support
.

However, clinical tests are constantly changing, and doctors can choose
according to specific clinical conditions.

Finally, note that blood lipids should be measured on an empty stomach when:

1.
When
the concentration of triglycerides in high-fat meals or daily postprandials is greater than 5 mmol/L.

2.
Patients
with hypertriglyceridemia who are in a follow-up state.

3.
Recovery period
of pancreatitis with hypertriglyceridemia.

4.
Drugs
that can cause severe hypertriglyceridemia are being used.

5.
At the same time, other test items require the use of fasting blood samples
.
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