[100-Year Life Health] Hyperlipidemia Treatment... Once Started, Continue Steadily Without Interruption

Angina, Myocardial Infarction, and Cerebral Infarction Account for Nearly 25% of Causes
As Symptoms Are Absent, Diagnosis Requires Screening

Professor Son Gi-yeong, Department of Family Medicine, Seoul Asan Medical Center.

Hyperlipidemia is also called dyslipidemia. It refers to having high levels of cholesterol or triglycerides. Among hyperlipidemias, high cholesterol is called hypercholesterolemia, and high triglycerides are called hypertriglyceridemia. Here, we will focus on the more important hypercholesterolemia.

There are several types of cholesterol. Among them, the commonly tested and discussed ones are HDL cholesterol and LDL cholesterol. HDL and LDL are lipoproteins, which can be thought of as vehicles that carry cholesterol. Depending on which vehicle cholesterol rides, its effect on the blood vessel walls differs. Cholesterol carried by the LDL vehicle tends to accumulate in our blood vessel walls and causes atherosclerosis.

When we talk about hyperlipidemia, it mostly refers to a condition where LDL cholesterol is excessively high and needs to be reduced. Therefore, LDL cholesterol is called "bad cholesterol." It is a cause of major cardiovascular diseases such as angina, myocardial infarction, and cerebral infarction. Hyperlipidemia accounts for nearly 25% of the causes of angina and myocardial infarction in Korean men. Even when considering all cardiovascular diseases, it is the third most important factor after smoking and hypertension. Nevertheless, many people do not consider hyperlipidemia as seriously as they should. According to data from 2016, only about 41% of people with hyperlipidemia receive proper treatment.

Hyperlipidemia has no symptoms. It must be detected through screening. If cholesterol levels are too high after screening, you should consult a doctor to start treatment. Whether or not treatment is started, if cholesterol is high, lifestyle changes should be made to lower the levels. The most important thing is to reduce saturated fats in our diet. Saturated fats are found in the fat of four-legged animals like cows and pigs, as well as in butter and ice cream, which are commonly consumed foods.

When this is mentioned, many people, especially women over middle age, often respond, "I don't eat much of those." In fact, many of them do consume relatively little saturated fat. Generally, it is recommended that saturated fat intake be less than 6% of total energy intake. According to the Korea National Health and Nutrition Examination Survey, Koreans consume just over 6% of their energy from saturated fats on average. Moreover, younger people tend to consume more saturated fat, while many middle-aged and older adults consume less than the 6% guideline. Still, it is encouraged to consider whether there is room to reduce saturated fat intake further. Although less effective than reducing saturated fat, weight loss can also help those who are significantly overweight.

Finally, it should be noted that, like hypertension, hyperlipidemia is a condition that requires continuous treatment once started. In clinical practice, many patients stop taking their cholesterol medication after seeing improved cholesterol levels in tests. However, if medication is stopped, cholesterol usually returns to its original high levels. Unless the patient is very old and frail or suffering from a severe illness, hyperlipidemia treatment should be continued once initiated.

Ki-Young Son, Professor, Department of Family Medicine, Asan Medical Center, Seoul