Principles of drug treatment and scientific weight loss strategies for obesity complicated with hyperlipidemia

Drug Treatment for Obesity

(I) Treatment Principles
Generally, dietary therapy should be implemented for 3-6 months before starting drug treatment. For patients diagnosed with coronary heart disease, such as those who have had acute myocardial infarction, undergone coronary artery bypass surgery, or angioplasty, or those with peripheral atherosclerosis, drug treatment and dietary therapy can be carried out simultaneously, especially for patients with initially high LDL (low-density lipoprotein) cholesterol levels, drug treatment should be initiated as early as possible. In addition to treating hyperlipidemia, other coronary heart disease risk factors should be corrected as much as possible.

1. Lowering LDL Cholesterol Levels
Currently, the focus of drug treatment is on LDL cholesterol, while also considering restoring TG and HDL (high-density lipoprotein) cholesterol to normal levels. In 1993, the Adult Treatment Committee of the US National Cholesterol Education Programme (NCEP) made recommendations on the principles of drug treatment, the starting LDL cholesterol level for treatment, and the required level after treatment (Table 13-1). Patients requiring drug treatment are divided into three main categories.

(1) Coronary artery disease or other clinical atherosclerotic diseases, such as peripheral vascular disease or symptomatic carotid artery disease.

(2) No coronary artery disease, but with two or more coronary artery disease risk factors.

(3) No coronary artery disease, but with fewer than two risk factors.

Coronary artery disease risk factors refer to factors related to the occurrence of coronary artery disease. These include factors such as age >45 years for men, age >55 years for women, family history of early-onset coronary artery disease, smoking, hypertension, HDL cholesterol <0.9 mmol/L (<35 mg/dL), and diabetes.

The expert committee recommends that premenopausal women and men under 30 years of age generally do not use lipid-lowering drugs, except for those with LDL cholesterol levels >5.7 mmol/L (>220 mg/dL).

2. Lowering Triglycerides and Raising HDL Cholesterol Levels Patients with high triglycerides or low HDL cholesterol, like those with high LDL cholesterol, should undergo dietary and exercise therapy in the first stage of treatment. There is no unified standard for whether to use medication for mild to moderate TG elevation (2.3–4.5 mmol/L). Some believe that medication is suitable for patients with moderate hypertriglyceridemia who also have coronary heart disease or other vascular diseases, diabetes, mixed hyperlipidemia, and certain hereditary hyperlipidemias such as familial mixed hyperlipidemia. These four types of patients especially need medication if their HDL cholesterol is also low.