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各位朋友：

大家好，现在是“每天健康三分钟”时间，我是安阳道简医院的医生白传威。今天主要和大家聊聊血脂的事情。在聊之前，先和大家说说我和小王打过的一通电话。

朋友小王的老爸三个月前心梗装了支架，昨天小王陪他去医院复查，顺便自己也查了，结果提示都是正常的，而且小王老爸的血脂比参考数值的最低值还要低，小王就打来电话问我，是不是用不用再吃降脂药了。

我相信很多人也是有这样的想法，以为血脂正常了，就可以不吃降脂药了，但这种想法对吗？

血脂水平是否正常不能光看化验单参考值，尤其是那些高危人群，比如小王的老爸，有心梗病史并且放过支架，如果不持续控制血脂和其他危险因素，血液里的“坏胆固醇”还会继续搞破坏，沉积到血管壁上，血管还会继续出现斑块。当斑块造成血管狭窄堵塞，或者斑块再次破裂形成血栓时，就会堵塞血管，引起心梗复发。心梗患者复发风险很高，十年内复发率可达到30%。如何预防心梗复发呢？首先要管好各种风险因素，如大家熟知的三高（高血压、高血脂、高血糖），尤其要管好“坏胆固醇”，它是心梗发作和复发的“罪魁祸首”。心肌细胞是不可再生的，心梗反复发作，最后可能就救不回来了。

化验单的参考值只针对健康人，健康人的“坏胆固醇”不超过参考值上限就是正常，可冠心病患者不能按照这个来。除了化验单上看得见的数值，还有考虑患者是否有心血管疾病，有多少危险因素。根据国内外最新研究成果，冠心病患者的“坏胆固醇”理想水平应该达到“14-50”， “14”指“坏胆固醇”的绝对值要小于1.4mmol/L；“50”指如果“坏胆固醇”无法降到1.4的，至少要在原先的数值基础上降低50%。依据已有研究证据，“坏胆固醇”每降低1mmol/L，5年内主要心血管事件减少22%。也就是说，血脂控制越低，再发心梗的风险越低。

说到这，大家都明白了吧！血脂数值在正常范围内，咱们还是需要继续口服降脂药物的，低密度脂蛋白胆固醇长期处于较低水平，有助于延缓动脉粥样硬化的进展，可以显著降低心梗的复发风险。

咱们今天的分享先到这里，想了解更多科普知识，请关注我们，咱们下期再见。

【英文版】

Is everything ok if blood fat is normal? You're wrong

Hello, everyone. It's time for "Health Talk for Three Minutes Every Day". I'm Bai Chuanwei, a doctor from Anyang Daojian hospital and Henan Zhonghui cardiovascular hospital. Today, I'd like to talk about blood lipids. Before we talk again, let's talk about a phone call I made with Xiao Wang.

My friend Xiao Wang's father had a stent for myocardial infarction three months ago.Yesterday, Xiao Wang accompanied him to the hospital for a review. By the way, he also had a check. The results showed that all of them were normal, and his father's blood lipid was even lower than the lowest value of the reference value. Xiao Wang called me to ask if he needed to take lipid-lowering drugs any more.

I believe many people have the same idea that if their blood lipids are normal, they can stop taking lipid-lowering drugs. But is this right?Whether the blood lipid level is normal can not only depend on the reference value of the test sheet, especially those high-risk groups, such as Xiao Wang's father, who has a history of myocardial infarction and has released stents.If blood lipids and other risk factors are not continuously controlled, the "bad cholesterol" in the blood will continue to damage the body,deposit on the blood vessel wall, and the plaque in the blood vessel will continue to form.

When plaque causes vascular stenosis and blockage, or plaque rupture again to form thrombus, it will block blood vessels and cause recurrence of myocardial infarction. Patients with MI have a high risk of recurrence, with a recurrence rate of 30% within 10 years. How to prevent recurrence of myocardial infarction? First of all, we should take good care of various risk factors, such as the well-known three high blood pressure (hypertension, hyperlipidemia, hyperglycemia),especially the "bad cholesterol", which is the "culprit" of myocardial infarction and recurrence. Myocardial cells are not renewable. If the myocardial infarction occurs repeatedly, the patient may fail to rescue in the end.

The reference value of the test sheet is only for healthy people. If the "bad cholesterol" of healthy people does not exceed the upper limit of the reference value, it is normal.However, patients with coronary heart disease can not refer to this normal range. In addition to the values visible on the test sheet,we should also consider whether the patient has cardiovascular disease and how many risk factors there are.

According to the latest research results at home and abroad, the ideal level of "bad cholesterol" in patients with coronary heart disease should reach "14-50". "14" means that the absolute value of "bad cholesterol" should be less than 1.4 mmol / L."50" means that if "bad cholesterol" cannot be reduced to 1.4 mmol/L,it should be reduced by at least 50% on the basis of the original value.According to the existing research evidence, every 1 mmol / L of "bad cholesterol" reduces the main cardiovascular events by 22% in 5 years.In other words, the lower the blood lipid control, the lower the risk of recurrent MI.

Speaking of this, we all understand! If the blood lipid level is within the normal range, you still need to continue oral lipid-lowering drugs. The long-term low-density lipoprotein cholesterol level will help delay the progression of atherosclerosis and significantly reduce the risk of recurrence of myocardial infarction

That's all for today's sharingIf you want to know more about popular science, please pay attention to us. See you next time.