Dyslipidemia · understanding cholesterol血脂异常 · 胆固醇该怎么看

Place · Level 3 · Condition

ApoB > LDL-C · 看心血管风险, 不单看数字 · 他汀是 A 级证据 · 饮食改 < 10-15%, 别期望饮食一项治根

Cholesterol · not a single number

Stop 1/5

胆固醇 · 不是单个数字

Dyslipidemia is the #1 modifiable risk factor for atherosclerotic cardiovascular disease (atherosclerotic cardiovascular disease: The plaque-clogged-artery family of disease — heart attack, stroke, peripheral artery disease.). Key knowledge: 'high cholesterol' is not about the TC (total cholesterol) number alone — it's about the atherogenic components.

Core indicators:

LDL-C: 'bad cholesterol', causally linked to ASCVDhigh-density lipoprotein cholesterol: The so-called 'good cholesterol' — it helps ferry excess cholesterol back to the liver.: 'good cholesterol', inversely associated (recent evidence challenges its causal protective role)TG (triglycerides): high TG reflects insulin resistance and independently increases risknon-HDL-C = TC - HDL-C: covers all atherogenic particlesapolipoprotein B: One sits on every artery-clogging particle, so counting it counts the harmful particles directly.: direct count of atherogenic particles, more accurate than LDL-C (especially with high TG / diabetes / obesity)lipoprotein(a): A largely gene-set lipoprotein particle that independently raises cardiovascular risk.: strongly genetically determined independent risk factor, measure at least once
Risk stratification (composite, not just numbers):

Very high risk: established ASCVD event / DM + target organ damageHigh risk: 10-year ASCVD risk ≥ 20% / severe risk factor (LDL-C ≥ 4.9 / severe HTN / long-standing DM)Moderate risk: 10-year risk 7.5-19.9%Low risk: < 7.5%
Key risk calculators:

PCE (Pooled Cohort Equations) — US AHA/ACCSCORE2 — European ESC, regional versions existChina-PAR — China-calibrated, recommended for Chinese populations
low-density lipoprotein cholesterol: The so-called 'bad cholesterol' — the higher it is, the more plaque tends to build in artery walls. targets (by risk tier, not 'lower is always better' blanket):

Low risk: < 3.0 mmol/L (116 mg/dL)Moderate risk: < 2.6 mmol/L (100 mg/dL)High risk: < 1.8 mmol/L (70 mg/dL) + LDL-C ↓ ≥ 50% from baselineVery high risk: < 1.4 mmol/L (55 mg/dL)

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