Hyperlipidemia in the elderly
Introduction
Introduction to hyperlipidemia in the elderly Hyperlipidemia refers to the content of one or more components in plasma lipids exceeding the normal high limit. The main components are triacylglycerol (TG), cholesterol ester (CE), phospholipid (PL), free fatty acid (FFA), etc. And TG is affected by age, gender, lifestyle, and eating quality. basic knowledge The proportion of sickness: 0.01% Susceptible people: the elderly Mode of infection: non-infectious Complications: arteriosclerosis
Cause
The cause of hyperlipidemia in the elderly
Cause:
Familial
Also known as primary, mostly genetic, caused by abnormal enzymes, the current cause is not clear.
2. Secondary
Atherosclerosis, diabetes, mucinous edema, nephrotic syndrome, pancreatitis, hepatobiliary disease, alcoholism, etc.
Pathogenesis:
Excessive or transformation of certain lipoproteins can affect CE and TG to varying degrees. The World Health Organization (WHO) can analyze lipoproteins based on chemical analysis, appearance, ultracentrifugation and electrophoresis of serum lipids. There are 5 categories: chylomicrons (CM), very low density lipoprotein (VLDL), ie, pre-beta-lipoprotein, intermediate density lipoprotein (IDL), low-density lipoprotein (LDL), -lipoprotein, high-density lipoprotein (HDL) is -lipoprotein; floating -lipoprotein, also known as wide -(-VLDL), part of normal human CE comes from cholesterol-rich foods such as egg yolk, butter, brain, internal organs (especially Liver is exogenous, and the other part is self-synthesis in the body. It is endogenous, 90% is synthesized by liver and intestinal mucosa. Plasma TG is exogenous in food, in CM, in the liver by sugar, etc. Synthetic to endogenous, in the presence of VLDL, such as increased blood CM after high-fat diet, creamy plasma, exogenous high TG, high-calorie diet, obesity, alcohol stimulation, etc., excessive VLDL production, liver When the synthesis and release of glycerides exceed the clearance rate or the clearance is relatively slow, the blood TG accumulates and produces Endogenous hypertriglyceridemia, abnormal lipid metabolism in the elderly, mostly due to obesity, drinking, taking antihypertensive drugs, diet and hyperinsulinemia.
Prevention
Elderly hyperlipidemia prevention
1. Early diagnosis of the cause and active treatment.
2. Low calorie, low fat diet.
3. Keep the biliary tract unobstructed and prevent blood lipids from rising.
4. Moderate exercise, weight control, and discomfort after meals.
Complication
Elderly hyperlipidemia complications Complications arteriosclerosis
Concurrent atherosclerosis, arteriosclerosis is an important complication of cardiovascular and cerebrovascular diseases.
Symptom
Symptoms of hyperlipidemia in the elderly Common symptoms Amnesia, tinnitus, dry eyes, dizziness, dizziness, chest tightness, angina, myocardial infarction, insomnia
1. Dizziness, tinnitus, head swelling, insomnia, forgetfulness, cerebral arteriosclerosis, cerebral embolism.
2. Have a history of diabetes, obesity.
3. Chest tightness, palpitation, angina pectoris, ECG suggesting coronary heart disease, severe myocardial infarction.
4. The vision is unclear, the eyes are dry, and the fundus arteries are hardened.
5. Pain in the liver area, B-ultrasound suggests fatty liver.
6. Lower extremity numbness, intermittent claudication, lower extremity occlusive arteriosclerosis.
The diagnosis of this disease mainly depends on laboratory tests, and the standard adopted by the National Institutes of Health (NIH) International Cholesterol Education Expert Group (NCEP) in 1988 is adopted. When the plasma CE6.20mmol/L (240mg/dl), LDL 3.36mmol/L (130mg/dl), TG2.82mmol/L (250mg/dl) and HDL/HOL-C0.91mmol/L (35mg/dl) can be diagnosed as hyperlipoproteinemia.
Examine
Examination of hyperlipidemia in the elderly
1. Determination of blood lipid profile Complete set including fasting TC, TG, LDL-C, HDL-C.
2. To determine the presence or absence of chylomicrons in plasma, a simple method is to place the plasma in a refrigerator at 4 ° C overnight, and then observe whether the plasma has a "creamy" top layer.
3. Plasma low density lipoprotein (LDL-C) concentration can be calculated using the Friedewald formula:
LDL-C (mg/dl) = TC-(HDL-C TG/5) or LDL-C (mmol/L) = TC-(HDL-C TG/2.2).
If the plasma triglyceride concentration is within 4.5 mmoL/L, the LDL-C concentration is calculated using this formula and the results are reliable. If the plasma triacylglycerol concentration exceeds 4.5 mmoL/L, this formula cannot be applied because the calculated LDL-C concentration will be significantly lower than the actual value.
The plasma cholesterol level may vary by ±10% within 1 to 2 weeks, and the laboratory variation is allowed to be within 3%. At least 2 records of blood specimen examination should be made before judging whether there is hyperlipidemia or determining prevention and treatment measures. .
Diagnosis
Diagnosis and differential diagnosis of hyperlipidemia in the elderly
In the diagnosis of hyperlipidemia, it should be clarified which type of abnormal lipid metabolism is involved (Table 4). Because hyperlipidemia caused by different reasons is different in treatment, it is necessary to distinguish primary hyperlipidemia from secondary hyperlipidemia, and then determine its specific cause. It is helpful for the differential diagnosis of various hyperlipidemias.
