Effect and Improvement of Lifestyle Intervention on Hyperlipidemia

Abstract

The study found that the abdominal circumference, body mass index, blood pressure, and blood lipid levels of the patients were significantly decreased after the healthy lifestyle intervention, and the proportion of smoking and alcohol abuse was significantly reduced. Healthy lifestyle intervention has become the key content of guiding the treatment of hyperlipidemia. Therefore, this chapter will briefly introduce the main pathogenic factors of hyperlipidemia in daily life, and then introduce the impact factors and improvement effect of lifestyle intervention on hyperlipidemia from four aspects of diet, exercise, psychological factors and risk factors in detail.

1. Introduction

With the advancement of people’s living conditions and technology, more and more sub-healthy phenomena have emerged in people’s body, which leads to many diseases. Among them, hyperlipidemia means an imbalance between the levels of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) in the blood, including hypertriglyceridemia and mixed hyperlipidemia, in which both total cholesterol (TC) and total triglyceride (TG) levels are elevated [1]. As one of the most commonly found and treated diseases in dyslipidemia, hyperlipidemia will be associated with cardiovascular diseases such as atherosclerosis [2]. Studies show that cardiovascular disease (CVD) is one of the leading causes of death among adults in the U.S. Compared to people with normal TC levels, people with hyperlipidemia have about twice the risk of developing CVD [3]. It poses a great risk to people’s health. Current clinical results show that few patients need drugs to lower TG and TC levels, and that lifestyle changes are the most effective way to improve hyperlipidemia [4].

Daily life interventions can improve hyperlipidemia in several ways: diet, exercise, psychological factors, and elimination of risk factors. Studies have shown that chronic high-calorie diets exhibit hyperinsulinemia and hyperlipidemia, as well as heavier body and gonadal fat weights [5]. Conversely, moderate rise in aerobic exercise and physical activity elevate HDL-C levels while reducing LDL-C, TC, and TG, thereby exerting a positive impact on patients with hyperlipidemia [6]. When there is a mood disorder, cholesterol levels may be affected by the acute mood state and thus change. There is evidence that cholesterol levels are elevated when depressive episodes occur, suggesting that the effect of mood states on cholesterol levels does also exist [7]. In addition, some poor lifestyles and habits as well as common diseases can also increase the risk of dyslipidemia. Over the past few decades, there has been a notable rise in the incidence of cardiometabolic risk (CMR) factors, including central obesity, insulin resistance, hypertension, and dyslipidemia, among individuals with type 1 diabetes. These factors may have an additive or synergistic effect on the risk of developing cardiovascular disease. This suggests that individuals with type 1 diabetes should not only focus on managing their blood sugar levels but also take measures to control other CMR factors to minimize their overall cardiovascular risk. Specifically, for individuals with multiple CMR factors, more aggressive interventions such as regular physical exercise, healthy dietary habits, and pharmacotherapy may be necessary [8].

Therefore, daily life interventions may have a positive impact on lipid levels in patients with hyperlipidemia and may be more effective as adjunctive therapy.

2. The effect and improvement of dietary patterns on hyperlipidemia

2.1 Pathological mechanism of hyperlipidemia caused by improper diet

During human metabolism, lipid metabolism is mainly regulated by nutrients such as sugars and fatty acids. Glucose is an essential energy material for normal metabolic activities, while glucose and fructose are the main utilization sugars. Compared with the use of glucose, the consumption of fructose by the body leads to an increase in the level of circulating apolipoprotein C3(Apo C3), which may be due to the failure of fructose to induce insulin secretion, stimulating the expression of Apo C3 and reducing the reverse transport of cholesterol. On the other hand, consumption of a high-glucose diet can induce the expression of Apo C3, which can increase the low-density lipoprotein (LDL) and subsequently impact the hydrolysis of triglycerides (TG) in chylomicrons (CM) and very low-density lipoprotein (VLDL) [9]. Therefore, a high-glucose diet, especially a diet with high fructose content, is a major cause of hyperlipidemia. Specifically, if the proportion of sugar intake is too high, it will increase insulin secretion, resulting in hyperinsulinemia, which promotes the synthesis of triglycerides in the liver, leading to an increase in the concentration of triglycerides in the plasma. In addition, the change in external factors such as high-glucose diet can also induce the increase in Apo C3 gene expression, resulting in the increase in plasma Apo C3 concentration, which will reduce lipoprotein lipase (LPL) activity, and further hinder the hydrolysis of triglycerides in CM and VLDL [9], thus causing hypertriglyceridemia. In general, a diet high in glucose can lead to an increase in blood triglyceride levels, which is a risk factor for hypertriglyceridemia and hyperlipidemia. High levels of blood lipids can increase the risk of developing cardiovascular diseases such as atherosclerosis and heart disease. Therefore, maintaining a reasonable dietary structure, limiting the intake of excess calories, and reducing a high-glucose diet are of great significance for the prevention and treatment of abnormal lipid metabolism.

Fatty acids (FA) are essential nutrients for vital activities and can be divided into saturated fatty acids (SFA) and unsaturated fatty acids (USFA). Animal fats are generally rich in SFA, while trans fatty acids (TFA) are present in butter, whole milk products, and ruminant meat and they are “partially hydrogenated fatty acids” of industrial origin [10]. SFA was the dietary factor that had the greatest effect on LDL-C levels, and LDL-C increased by 0.02–0.04 mmol/L for each 1% increase in energy from saturated fat. Dietary TFA increased LDL-C in a similar manner to SFA, but TFA reduced HDL-C [11]. In addition to the effects on cholesterol levels, lipid metabolism may also be affected by the interaction of dietary lipids with intestinal microflora. This interaction may lead to abnormalities such as lipid metabolism disorders in the body [12]. Hypercholesterolemia is also a common symptom of hyperlipidemia. The synthesis of cholesterol in the body will be promoted due to a diet high in calories, cholesterol, and saturated fatty acids, leading to an increase in liver cholesterol content. In addition, the receptor synthesis of LDL is decreased, and the receptor activity of LDL on the cell surface is further decreased, so that the affinity of LDL with its receptor is decreased, and the cholesterol level in blood is increased. Conversely, if you eat a low-calorie diet, unsaturated fatty acids can affect the activity of enzymes involved in cholesterol synthesis, resulting in lower blood cholesterol levels. Therefore, the FA composition in the diet has an important effect on lipid metabolism and cholesterol level in the body. In daily diet, the intake of USFA should be moderate, and the intake of SFA and TFA should be limited to maintain good lipid metabolism and healthy cholesterol levels.

2.2 Clinical manifestations of hyperlipidemia caused by improper diet

The clinical manifestations of hyperlipidemia caused by improper diet will vary according to the severity of the disease and the types of elevated blood lipids, while hyperlipidemia often causes lesion damage to the heart, brain, skin, and other places. The clinical manifestations are mainly xanthoma, early-onset corneal ring, fundus changes and arteriosclerosis, etc. However, in the majority of early onset, patients have no obvious symptoms and signs [13]. Specifically, common clinical manifestations include the following:

(1) Xanthoma: Xanthoma varies in size and there are small masses as well as large plaques. It occurs frequently in the eyelids, and may occur in the hands, feet, and certain joints. Xanthomas are usually painless, but may cause itching or irritation. Xanthoma is caused by the accumulation of cholesterol in the skin and may be a marker of high LDL-C levels. (2) Rings for the elderly: Rings for the elderly are more common in the elderly and are usually bilateral. It is caused by the deposition of cholesterol in the eye and may be a sign of high cholesterol levels in the blood. The ring around the cornea of the eye is either intact or incomplete. It is more obvious in the upper part of the cornea. Although the ring in the elderly is usually asymptomatic, it may be a sign of potential cardiovascular disease. (3) Retinal hyperlipidemia: It is a rare disease, usually caused by extremely high levels of triglycerides (higher than 1000 mg/dL), which can lead to visual impairment or even blindness if not treated immediately. (4) Peripheral artery disease: High cholesterol levels lead to the accumulation of plaques in the arteries that supply blood to the legs and arms, leading to peripheral artery disease that manifests as leg pain, numbness, and weakness. (5) Abdominal pain: High level of triglyceride will lead to acute pancreatitis, causing severe abdominal pain, nausea, vomiting, and fever. (6) Fatigue: High levels of lipids in the blood lead to fatigue and weakness, but this symptom may be a non-specific symptom of hyperlipidemia. (7) Cardiovascular disease: High levels of LDL-C can lead to the development of atherosclerosis, which can cause CVD, including heart attack and stroke. (8) Hypertension: High level of lipids in blood will lead to hypertension, which is a common complication of hyperlipidemia.

In general, the clinical manifestations of hyperlipidemia caused by poor diet include benign skin diseases to life-threatening CVD. Therefore, timely dietary intervention and regular detection of blood lipid levels are the key to the prevention and treatment of hyperlipidemia and its complications.

2.3 How to change the diet will improve hyperlipidemia

With the deepening of research on hyperlipidemia, in addition to drug treatment, treatment options to improve hyperlipidemia by changing dietary patterns have received more and more attention. These strategies include reducing the intake of cholesterol and saturated fatty acids, and consuming lipid-lowering foods [14, 15]. In daily diet, we should pay attention to control the intake of cholesterol and saturated fatty acids, and eat more foods rich in USFA and reducing blood lipid in order to maintain a good blood lipid level.

1. Eating food rich in dietary fiber (DF) [16] is an effective method for reducing blood lipid. DF refers to the sum of edible plant components, carbohydrates, and similar substances that are resistant to digestion and absorption in the small intestine of the human body but can be partially or completely fermented in the large intestine. According to whether it is soluble in water, it can be divided into soluble cellulose and insoluble cellulose [17]. Studies have shown that common cardiovascular diseases such as hyperlipidemia, hypertension, and coronary heart disease are related to the insufficient intake of DF [18]. DF can increase the fullness of the stomach on the one hand, reduce the intake of energy such as food, and play a role in the prevention of obesity. On the other hand, it can increase gastrointestinal peristalsis, improve the environment of the digestive tract probiotics, and then promote the excretion of toxins in the body, reducing the incidence of high cholesterol [19]. At the same time, DF can play an inhibitory role in the absorption of cholesterol and triglyceride by the lymphatic system, thereby promoting the normal operation of lipid and lipoprotein metabolism in the body. Three plants rich in natural DF, such as radish, beet, and Chinese cabbage, could significantly reduce the triglyceride content in serum and liver and improve the abnormal phenomenon of lipid metabolism in the body [20]. In addition, research has also focused on composite dietary fiber (DFC). The results showed that DFC prepared with sea buckthorn peel, bean gum, and oat bran as the main raw materials had a significant efficacy in reducing blood lipid. In conclusion, intake of food rich in dietary fiber is a natural, mild, and effective method for reducing blood lipid. In daily diet, it is recommended to eat more foods rich in dietary fiber, such as vegetables, fruits, whole grains, in order to maintain a good blood lipid level.

2. The intake of USFA is also an effective method for reducing blood lipid [21]. Compared with the saturated fatty acids in most animal fats and oils, many vegetable oils are rich in a variety of unsaturated fatty acids and have received widespread attention. For example, studies have shown that celery seed oil is rich in unsaturated fatty acids such as palmitic acid, oleic acid, and linoleic acid. On the one hand, it can significantly reduce the levels of TC, TG, and LDL-C in serum of hyperlipidemia and the arteriosclerosis index LDL-C/HDL-C. On the other hand, the activity of superoxide dismutase (SOD) in serum and liver is remarkably improved. It was further proved that celery seed oil could enhance the activity of antioxidant enzymes, effectively improve the antioxidant level in the body, remove excess free radicals in the body, and avoid the damage of lipid peroxidation and its intermediate metabolites to the body, thereby improving blood lipid metabolism. The camellia seed oil in the vegetable oil can not only reduce the serum TG and TC levels, but also alleviate the fatty lesions in the liver. All of the above are unsaturated fatty acids rich in oil plants; however, the unsaturated fatty acids rich in natural algae cannot be ignored. Studies show that Chlorella also has a significant effect on reducing blood lipid and is an option to alleviate hyperlipidemia [21]. In addition to vegetable oils, marine animal fats and oils such as fish also contain unsaturated fatty acids, which can reduce the contents of TG and TC in the blood and increase the content of HDL-C in the blood. At present, natural fish oil has been widely used in clinical practice as a lipid-lowering drug, which mainly inhibits the activity of hydroxymethylglutaryl coenzyme -A(HMG-CoA) reductase and reduces the synthesis of TC in vivo, while feeding back the up-regulation of LDL receptor level on the surface of hepatocytes to eliminate plasma LDL. However, it should be noted that in people with acute pancreatitis, high concentrations of USFA can cause damage to acinar cells and promote the development of pancreatitis. USFA may play a unique role in the pathogenesis of pancreatitis by activating PKC family members [22].

3. Foods rich in polysaccharides have attracted much attention due to their lipid-regulating activity, with fungal polysaccharides as the major ones, such as Ganoderma, Lentinus edodes, Auricularia, Grifola frondosa, Russula, Monascus, Poria, Cordyceps, Agaricus blazei, Tremella, Dictyophora indusiata, Coriolus versicolor, Cordyceps militaris, Armillaria mellea, Pleurotus ostreatus, and Flammulina velutipes. Ganoderma lucidum is taken as an example. Modern medical pharmacology research and clinical application have proved that Ganoderma lucidum not only has the functions of delaying aging, improving immunity and anti-inflammation, but also has the efficacy of reducing total cholesterol and regulating blood lipids [23]. Studies have shown that Ganoderma lucidum polysaccharides (GLP) and alkaloids contained in Ganoderma lucidum are the main active components that play a role in the regulation of blood lipids, and can play a role in reducing serum TG and TC [24]. As for the mechanism, it is currently more considered that GLP may reduce the synthesis of TC and TG in vivo by inhibiting the expression of key enzymes in the lipid synthesis pathway. In cell experiments, GLP was found to inhibit the mRNA expression of hydroxymethyl glutaryl coenzyme -A(HMG-CoA) reductase and fatty acid synthase (FAS) in HepG2 cells [25]. In addition to Ganoderma, other edible fungi are also rich in a variety of polysaccharides, such as lentinan, Auricularia auricula polysaccharide, have a certain effect on the regulation of blood lipids. Therefore, eating foods rich in polysaccharides is a very healthy dietary choice and an effective method for preventing and treating hyperlipidemia.

4. Foods containing polyphenol compounds have attracted much attention in the development of antioxidant health products. Polyphenols play an important role in increasing the levels of HDL and adiponectin, and preventing the oxidation of LDL. Common polyphenol compounds include anthocyanin, grape seed oil, astaxanthin, and lutein. Cinnamon is rich in polyphenols, which can activate transcription factors and antioxidant defense signaling pathways in the liver to reduce hyperlipidemia, inflammation, and oxidative stress [26]. Previous studies have shown that in France and some countries and regions with high wine consumption, even if people have the habit of high-fat diet, the incidence of cardiovascular disease is not high. This may be due to the antioxidant activity of polyphenols in wine and their effect in reducing total cholesterol absorption by increasing bile acids divided by. Gamboge is a plant growing in northeastern India. Its fruit is rich in polyphenols. Studies have shown that the fruit extract of this plant has a positive role in the prevention of hyperlipidemia [27]. In addition to food, drinking tea can also prevent hyperlipidemia and its concurrent diseases [28]. Tea is rich in catecholamine-based tea polyphenols. The current research has shown that tea polyphenols can improve the level of HDL-C and lecithin-cholesterol acyltransferase (LCAT) activity, and inhibit the intestinal absorption of exogenous TC, inhibit the activity of eugenol epoxidase to reduce TC biosynthesis, up-regulate LDL receptor level, reduce the secretion of apolipoprotein B100(ApoB100), accelerate TC transformation, and promote TC excretion to regulate TC metabolism. On the other hand, tea polyphenols reduced the absorption of exogenous TG and the activity of FAS by inhibiting the activity of pancreatic lipase to reduce fatty acid synthesis. At the same time, tea polyphenols regulate TG metabolism by accelerating the conversion of TG and promoting the excretion of fatty acids. Foods and drinks containing polyphenols are a very healthy dietary choice and an effective way to prevent and treat hyperlipidemia and its related conditions.

5. Foods containing flavonoids and isoflavones have strong activity in the prevention and treatment of hyperlipidemia. Many studies reported the lipid-lowering effect of total flavonoid extracts from plants. Hawthorn leaves and fruits are high flavonoid content of food. Animal experiments showed that flavonoids could significantly reduce the levels of TC, TG, and LDL-C in hyperlipidemia rats, and played a significant role in the regulation of lipid metabolism in hyperlipidemia rats to improve their disorders. In a study on oat flavonoids, the researchers focused on the intestinal flora and showed that oat flavonoids had anti-hyperlipidemia effect by interfering with bile acid metabolism and intestinal microflora [14]. In addition, the effect of flavonoids on reducing blood lipid was closely related to the number of free methylations. Studies have shown that the more methylation, the stronger the effect of flavonoids in reducing blood lipid. Isoflavones were corresponding to flavonoids. The main active components of soybean isoflavones were free aglycones genistein (Gen) and daidzein (Den). Similarly, soy isoflavones also reduced TC, TG, and LDL-C levels in hyperlipidemia, although its effect is not obvious [29].

6. Vitamin plays an important role in lipid metabolism. Among them, the effect of vitamin D is the most significant [30]. Vitamin D can reduce the acetylation or oxidation of LDL-C and inhibit the absorption of acetylated and oxidized LDL by macrophages to reduce the formation of foam cells and inhibit the formation of plaques. However, it should be noted that vitamin D is a double-edged sword for vascular calcification. Excessive or lack of vitamin D can lead to vascular calcification. Vitamin E is an important antioxidant in the body. Although the mechanism of its regulatory effect on blood lipid is not clear, hyperlipidemia has been determined to be inhibited by high vitamin E intake at animal levels. In addition to the antioxidant effect of vitamin E, vitamins A and C also have a certain antioxidant capacity, which can be used as an auxiliary prevention and treatment strategy of hyperlipidemia.

In conclusion, prevention and adjuvant treatment of hyperlipidemia are extremely important by reducing the intake of cholesterol and saturated fatty acids, supplemented by a diet that reduces blood lipids.

3. The effect and improvement of exercise on hyperlipidemia

3.1 Mechanism of action of insufficient exercise on dyslipidemia

Studies have shown that good regular exercise can activate LPL in skeletal muscle and fat cells, promote the balanced transfer of VLDL and HDL-C, reduce serum TC, TG, and LDL, and increase HDL-C levels. Lack of exercise leads to a decrease in triglycerides depleted, an increase in endogenous triglyceride synthesis; moreover, it reduces LPL activity, slowing down triglyceride clearance which is especially common in the elderly [1]. When there is a lack of exercise, the secretion of epinephrine and norepinephrine decreases, and reduces the activity of LPL and the decomposition of fat in adipose tissue. At the same time, if the secretion of adrenaline and norepinephrine decreases, it may lead to the decrease of lipolysis, and at the same time, the activity of lipoxygenase increases, leading to the increase in fat synthesis. It is well known that short-term high-intensity exercise is mainly powered by sugar, while moderate-intensity long-term exercise is mainly powered by fat. During exercise, the body increases the call to triglycerides, muscles will enhance the intake of free fatty acids in the blood, and lack of exercise will lead to a decrease in mobilized triglycerides, thereby reducing the appearance of free fatty acids in the blood, also leading to a decrease in the intake of free fatty acids in the blood by muscles. At the same time, it should be noted that high triglyceride levels promote the occurrence of other metabolic disorders such as diabetes and CVD [31]. A lack of muscle exercise can impair glucose utilization, leading to the conversion of excess glucose into fat and increasing fat formation and accumulation in the blood. Regular exercise can improve insulin sensitivity and glucose uptake in muscles, which can help to prevent the conversion of excess glucose into fat and reduce the amount of fat in the blood. In general, exercise is extremely important for the prevention of CVD, and the lack of exercise increases the incidence of cardiovascular disease [32]. At the same time, as a way to prevent CVD and treat diabetes, the role played by exercise training should not be ignored [33].

In addition to the traditional mechanisms described above, other studies have revealed mechanisms by which lack of exercise alters lipid profile. Lack of exercise leads to less TG consumed by muscle tissue and a decrease in LPL, resulting in less TG hydrolysis. More subtilisin-invertase 9 (PCSK9) allows the liver to absorb and excrete less LDL, thereby increasing the amount of lipids in the blood.

3.2 Physical manifestations of hyperlipidemia caused by exercise

Hyperlipidemia is when blood levels of lipids such as cholesterol and triglycerides are higher than normal, which can lead to health problems such as heart disease and stroke. Exercise is an effective way to lower blood lipid levels, but if exercise is excessive or inappropriate, it can also lead to some physiological problems.

Hyperlipidemia caused by exercise is mainly manifested in the following aspects:

(1) Muscle damage: Excessive exercise can cause muscle damage, releasing substances such as myoglobin and creatine kinase, which can affect liver function and lead to elevated cholesterol levels. (2) Muscle fatigue: Excessive exercise can fatigue muscles, which affects the oxidative metabolism of fatty acids, allowing fat to accumulate in the body, resulting in elevated blood lipid levels. (3) Active problems: Excessive exercise may lead to digestive disorders such as gastrointestinal discomfort and diarrhea, which may affect the absorption and metabolism of fat. (4) Hydration status: Excessive exercise may lead to dehydration, which may affect the concentration and metabolism of lipids in the blood.

Therefore, it is necessary to pay attention to the reasonable control of the amount of exercise to avoid hyperlipidemia caused by excessive exercise. In addition, it is necessary to combine diet, lifestyle, and other factors to comprehensively reduce blood lipid levels to maintain good health.

3.3 Improvement effect of different exercise methods and exercise intensity on hyperlipidemia

Previous studies have shown that exercise training can improve blood lipids, although to a limited extent. Different exercise methods and exercise intensity hyperlipidemia bring different improvements, the following will take specific studies as an example to explain the effects of different exercise modes and exercise intensity on blood lipid changes.

1. Aerobic exercise. Aerobic exercise is the most common and popular form of exercise. Aerobic exercise is defined as any form of physical activity that raises heart rate and breathing volume to meet the oxygen needs of the muscles that activate. Aerobic exercise is easier to perform than medication and has fewer side effects. Experiments have shown that aerobic exercise can significantly reduce blood lipids and increase HDL-C [34]. Several studies have further analyzed the effects of different aerobic exercise intensity and duration on lipids. For example, Kraus et al. randomized 111 overweight patients with mild-to-moderate dyslipidemia and sedentary habits into a control group and three aerobic training groups: high-intensity/high-activity aerobic exercise, high-intensity/low-exercise aerobic exercise, and moderate-intensity/low-exercise aerobic exercise. The results showed that the blood lipid changes in the high total exercise group and the high-intensity group were significantly better than those in the low total exercise group and the control group. The improvement in lipid levels in the low total exercise group was better than in the control group [35]. These findings indicate that overall aerobic exercise has a greater impact on blood lipid levels compared to the intensity of exercise. Within a certain range of exercise intensity, increasing exercise intensity can enhance the beneficial effects on blood lipids, but beyond a certain point, the positive effects of exercise on blood lipids tend to diminish. For instance, research has shown that low-intensity exercise can improve lipoprotein cholesterol compared to short-term high-intensity exercise [36].

2. Resistance training, also known as strength training. Studies have shown that strength training of a certain intensity can also significantly reduce blood lipid levels in the body. For example, a prospective study of lipid and lipoprotein levels in previously sedentary men (mean age 33) and women undergoing 16 weeks of weight training (mean age 27) found that after 16 weeks of strength training, women reduced cholesterol by 9.5%, LDL-C by 17.9%, and triglycerides by 28.3%. The ratio of total HDL-C and low-density lipoprotein cholesterol-high lipoprotein cholesterol decreased by 14.3% and 20.3%, respectively. In men, LDL-C was reduced by 16.2 percent, while the proportion of total HDL-C and LDL-C decreased by 21.6 and 28.9%, respectively [37].

3. Effects of aerobic training in combination with other training on lipids. The combination of strength training and aerobic training can improve lipid metabolism by increasing the activity of key enzymes and promoting the breakdown and excretion of fats and cholesterol. This can lead to improvements in cardiovascular health and a reduced risk of metabolic diseases such as hyperlipidemia and atherosclerosis. Strength training combined with aerobic training can better promote the secretion of lipolytic hormone in the body and reduce insulin secretion. It not only increases fat mobilization and burning, but also increases the gene expression level of high-density lipoprotein receptor, increases the induction synthesis of HDL-C-related APOA1 apolipoprotein, increases the level of HDL-C in the body, and also reduces the level of LDL-C in the blood, so that the body can improve the metabolic capacity of cholesterol and cholesterol esters, and achieve the purpose of reducing blood lipids.

In addition to the above-mentioned exercise, Tai Ji Chuan in the prevention and improvement of hyperlipidemia has been studied, the study shows that Tai Ji Chuan in the promotion of whole body blood lectured, regulating blood lipids in the human body, etc. [38]. Brisk walking is very popular among middle-aged and elderly people, while patients with hyperlipidemia can choose the exercise time and intensity according to their own situation to achieve the purpose of alleviating hyperlipidemia.

3.4 Establish reasonable exercise habits

There is no doubt that exercise has a clear regulatory effect on blood lipids, and numerous studies have shown that exercise not only has a positive effect on dyslipidemia patients, but also helps to improve blood lipid status. However, there are many things to be aware of before starting to exercise. The most important thing is to choose the right exercise method for your physical condition and make a reasonable exercise plan. Reasonable exercise habits can help you better reduce blood lipids, improve dyslipidemia, and maintain health.

1. Be sure to warm up before exercise, warming up can improve the excitability of the central nervous system and muscles—awaken all parts of the human body involved in movement, and improve the excitability of the neuromuscular system. Improve muscle blood supply, activate muscle fibers, accelerate the contraction and relaxation of active muscles and antagonist muscles, produce a post-activation enhancement effect, and increase the contraction speed and contraction force of muscles, and be more conducive to exercise [39]. After warming up and raising body temperature, the elasticity and stretch ability of muscles and ligaments increases, so that muscle viscosity decreases, elasticity is enhanced, and the probability of sports injuries is reduced, and at the same time, by increasing body temperature, accelerating the speed of energy supply to the body, strengthening the metabolic process of substances in the body, it can also consume more fat and better reduce blood lipids.

2. Reasonably plan your exercise intensity and exercise time. Too high or too low exercise intensity is not conducive to causing significant improvement in blood lipids. Most of the beneficial changes occur when the intensity of exercise training is between 50 and 70% of the maximum oxygen uptake, and high-intensity exercise training does not appear to bring more beneficial changes than moderate- and low-intensity exercise training. Animal experiments have also confirmed that too high-intensity endurance exercise training not only does not improve dyslipidemia, but may accelerate the occurrence of dyslipidemia. Therefore, too intense exercise intensity or too long exercise is not suitable. The intensity of exercise is best at moderate intensity and is not recommended to exceed it. The test is based on your heart rate per minute to judge your exercise intensity. The target heart rate value is calculated as: [220-age (1 year old)] × 60–70%, which is the moderate-intensity exercise range, and be sure to use the heart rate intensity range that you can accept. In terms of exercise time, exercise for at least 30 minutes a day, and 60 minutes is better. If it is difficult to exercise for 30 minutes at a time, start with 10 minutes and accumulate through multiple 10 minutes to 30 minutes. LDL is the largest part of total cholesterol, this reflects changes in total cholesterol levels. For people who want to improve hyperlipidemia, lowering higher LDL indicators is the most important goal. This requires at least 250–300 minutes of aerobic exercise per week, burning about 2000 kilocalories to help reduce fat content and body weight, and is expected to reduce LDL-C by about 5–8% after 12–16 weeks.

4. The influence and regulation of psychological factors on hyperlipidemia

4.1 Mechanism of action of psycho-emotional state on lipid metabolism

Usually, when a person is in a stable emotional state, the lipid metabolism process does not undergo significant changes. The metabolism of triglycerides, phospholipids, cholesterol, and plasma lipoproteins is regulated by insulin, glucagon, diet, nutrition, biochemical enzyme activity in the body, and other complex and precise regulations, and is transformed into material components required for various fine biochemical reactions in the body. The liver, adipose tissue, and small intestine are important sites for synthesizing fat, with the liver having the strongest synthesis ability. After synthesis, it needs to combine with apolipoprotein, cholesterol, etc., to form extremely LDL, which is transported into the bloodstream and stored or utilized in extrahepatic tissues.

When psychological stress occurs, lipid metabolism changes accordingly, and psychological stress includes two types: chronic and acute. Previous studies have shown that acute psychological stress has a relatively small impact on blood lipids, while chronic psychological stress may have a more significant impact on the occurrence and development of CVD. The mode of action of acute psychological stress is relatively strong and one time; chronic psychological stress is relatively mild, but it occurs frequently and lasts for a long time, usually from days to months. At present, the mechanism by which stress causes an increase in plasma lipid concentration is still unclear. One viewpoint is to use a stress-induced lipolysis model to explain the increase in blood lipids, which refers to an increase in cholesterol secretion by the liver during the stress process, leading to an increase in circulating cholesterol concentration. Adrenaline affects the activity of lipoprotein lipase, liver lipase, and other hormone-sensitive lipases, thereby increasing the release of fatty acids from adipose tissue and providing the liver with substrates for the synthesis of TG and VLDL. In vitro experiments have shown that adrenaline can effectively inhibit the secretion of lipoprotein lipase and human leukocyte antigen after translation. In addition, adrenaline may directly stimulate the release of free fatty acids in adipose tissue, which accelerates the process of liver cholesterol secretion.

4.2 Interaction between dyslipidemia and mental state

The psychological risk factors of patients with hyperlipidemia include somatization, interpersonal disorders, marital discord, anxiety, depression, and anger. At the same time, it was also found that the psychological risk factors of hyperlipidemia patients include age, educational level, gender, lifestyle habits, dietary structure, body mass index, and potential social discrimination. Patients with long-term hyperlipidemia often also suffer from diseases such as coronary heart disease and pancreatitis. These diseases can bring great mental pressure to patients, leading to extreme emotions such as anxiety and anger. Under the influence of extreme emotions, physical and mental health can face great threats. Emotional regulation plays an important role in alleviating the negative impact of dyslipidemia on mental state. Type 2 diabetes mellitus (T2DM) can cause secondary hyperlipidemia. Patients with type 2 diabetes treated with insulin typically have more comorbidities [40]. Emotional distress was the most common type of distress in T2DM patients using antihypertensive or antihyperlipidemic medications [41]. High blood lipids can also cause other diseases, and hypercholesterolemia are possible risk factors for restless leg syndrome [42]. Dyslipidemia is the main cause of cardiovascular complications in diabetes mellitus (DM) [43].

Different people have different psychological resilience, pressure resistance, and perception of the external environment, so the way they handle negative emotions also varies. Some people are very sensitive, while others are not easily influenced. Faced with the generation of negative emotions, a group of people usually resort to the bad practice of overeating. Impulsive behavior when distressed exacerbated the link between weight-based teasing distress and loss of control eating frequency [44]. Overweight patients should be informed that there is not only a risk for the commonly known consequences such as diabetes, hypertension, coronary artery disease, and heart failure, but also that there is a greater risk of developing atrial fibrillation and a subsequent risk of stroke and death [45]. This usually leads to a sudden increase in obesity and a surge in body mass index. There is a close relationship between body mass index and hyperlipidemia patients, and the higher the body mass index, the higher the incidence rate. Obese people accumulate a large amount of fat in their bodies, which leads to the accumulation of triglycerides in the liver endoplasmic reticulum. They cannot combine extremely dense lipoprotein to secrete into the blood circulation, which leads to the disorder of fat metabolism and the increase of blood lipids.

To alleviate the mental stress caused by dyslipidemia, patients should avoid emotional tension and excessive excitement, which can cause an increase in blood cholesterol and triglycerides levels. In such cases, small doses of sedatives can be used, to avoid mental side effects caused by long-term medication use by patients.

4.3 How to maintain a good mood

Current guidelines do not stipulate the atherogenic lipid profile in the postprandial state as a target for therapy nor do they give any target values for the parameters of postprandial hyperlipidemia [46]. Therefore, maintaining a good emotional state is necessary for physical and mental health, and the following activities can be used to maintain a good mood. Some people choose to use prayer to maintain stable emotions. We did not find a significant association between the perceived appropriateness of one’s emotional reaction and use of prayer to manage emotions [47]. You can go to a hair salon to get a new hairstyle. Psychologists believe that if a person change their hairstyle when their mood goes bad, it can suppress the early onset of bad emotions and interfere with the production of hormones that cause depression. Moreover, changing hairstyles can provide psychological relaxation and pleasure, leading to an improvement in mood. Limited social competence hinders acquisition of adequate coping strategies [48]. A balanced diet is also important for maintaining health and maintaining a healthy mindset. Firstly, add sweet potatoes or yams to rice. Secondly, it is important to eat more leafy vegetables and add nuts to the dishes. Crushed nuts can not only be seasoned, but also reduce the use of salt. The third is that appropriate seaweed can be added to the soup.

The improvement of mood through exercise cannot be ignored. Individual responses to anger reduction are idiosyncratic and the match between the individual and the activity may be more crucial than the activity itself [49]. Regular and moderate exercise can help us overcome symptoms of depression and anger. Compared to using medication, exercise can alleviate stress caused by lipid abnormalities. Exercise can alleviate anxiety. Anxiety is another extremely common emotional disorder, manifested in a loss of interest in life and fear of bad outcomes, helping people restore inner peace and relaxation. Through the continuous accumulation of exercise, people will also gain higher self-esteem and increased confidence through self-transcendence. We can also do more mental health tests in our daily lives to ensure that our emotional state is in a relatively positive state, in order to make timely adjustments. But remember, whatever the mechanism, it will be important to determine whether mental stress testing provides additional risk prediction above and beyond the other traditional risk stratification tools in different categories of patients [50].

5. The impact and prevention of risk factors on hyperlipidemia

5.1 Close relationship between bad lifestyle habits and hyperlipidemia

Studies have shown that smoking, alcohol consumption, lack of physical activity, and low intake of vegetables and fruits are positively associated with dyslipidemia [51].

The rate of dyslipidemia in smokers is significantly higher than in non-smokers. This is because the nicotine and carbon monoxide contained in tobacco can increase oxidative modification, enhance platelet agglomeration, increase the content of TG, TC and LDL-C in the body, and reduce the content of HDL-C [52]. Smoking can affect blood lipid metabolism, and long-term smoking will promote platelet aggregation and coronary thrombosis, lead to a decrease in vascular endothelial progenitor cells, slow down the new generation of micro-vessels, and damage to large blood vessel repair [53]. At the same time, it leads to oxidative stress and inflammatory response, so that the coagulation fibrinolytic system in the body is dysfunctional. Moreover, it affects blood lipid metabolism, and induces or aggravates atherosclerosis and coronary artery spasm. The TC level of smokers was positively correlated with the age of cigarettes smoked and the number of cigarettes smoked, while the HDL-C level was negatively correlated with it. The greater the amount smoked by smokers, the higher the total cholesterol, total triglycerides, TC/HDL, apolipoprotein, and LDL, which were significantly higher than those who smoked a small amount and did not smoke. Its HDL and apolipoprotein are significantly lower than those who smoke a small amount and those who do not smoke. The rate of dyslipidemia in people who drink too much is significantly higher than in those who drink little or non-alcohol [54]. Since alcohol can increase the mobilization of peripheral adipose tissue in the human body, increase the synthesis of triacylglycerol in the liver, and reduce the oxidation of fatty acids, resulting in hyperlipidemia, the higher the amount of alcohol intake, the higher the incidence of dyslipidemia. Long-term heavy drinking can lead to alcoholic liver disease [55], which initially manifests as fatty liver. Patients with alcoholic liver disease have poor liver reserve and lipid levels decrease significantly as the disease progresses. In patients with alcoholic fatty liver disease, blood lipids are increased, and triglycerides are more pronounced. The patient’s liver function level will decrease with the degree of decompensation of cirrhosis, and the blood lipid TG and TC levels will also decrease. Alcoholic liver disease severely affects lipid metabolism, so changes in liver function are often accompanied by changes in lipids.

In addition, the risk of chronic diseases may be higher in people who regularly eat smoked bacon compared to those who do not eat smoked bacon. The risk of chronic diseases may also be higher in people who frequently eat out or socialize compared to those who do not or only occasionally do so. On the other hand, people who consume moderate amounts of meat may have a lower risk of chronic diseases compared to those who eat a lot of meat. Bad lifestyle habits are an important influencing factor in the development of chronic diseases. However, the prevention of chronic diseases is a complex issue that involves multiple factors in their pathogenesis.

5.2 How to reduce the risk of risk factors for dyslipidemia

Dyslipidemia is easily overlooked because it is not accompanied by obvious clinical manifestations, but the various diseases caused by it can seriously affect the quality of people’s life. Current research suggests that dyslipidemia’s mechanisms are closely related and interconnected, and co-occurring chronic diseases are common. However, many potential mechanisms of action still need to be explored further. The interaction of multiple chronic diseases can pose greater health hazards to the population than single-disease chronic diseases [56]. For people with high-risk factors, effective prevention and treatment measures can help reduce the risk of dyslipidemia and its associated health risks. It is particularly important to prevent the occurrence of chronic diseases, especially chronic comorbidities.

We should focus on the lipid levels of patients with hypertension, diabetes, and hyperuricemia, especially in donors who are closely related to cardiovascular disease, to prevent the occurrence of cardiovascular disease. It is suggested that relevant departments should incorporate school testing into the free routine physical examination items for residents when formulating health prevention strategies and measures, use community resources to advocate a healthy lifestyle, adopt comprehensive measures such as scientific diet, reasonable nutrition, smoking cessation and alcohol abstinence [57], recompose sleep, control weight, strengthen exercise, and control blood sugar of diabetic patients to reduce blood lipid levels, and reduce the prevalence of dyslipidemia and the prevalence of chronic diseases. Try to achieve early detection and early treatment of chronic diseases, reduce the occurrence of complications and disabilities, reduce the pain of patients, and improve the health level of patients. High-risk groups and patients need to understand diseases, standardize behavior and lifestyle, reduce risk factors, improve the awareness, treatment, and control rates of high-risk groups with dyslipidemia, correct bad living habits, and better grasp disease prevention and prevention measures [58].

Lifestyle therapy is the core strategy of dyslipidemia management, and strengthening health awareness and awareness of related disease risks, developing healthy lifestyle, and eating habits have become the key to prevention and treatment. Therefore, residents can adopt some measures in their lifestyle to reduce the risk of dyslipidemia risk factors, such as low-carbohydrate diet and Mediterranean diet [59], actively improve dietary nutritional structure [60, 61], and at the same time carry out appropriate activities to prevent calorie accumulation [62]. These measures were all associated with reduced TG levels and elevated HDL-C levels. Among them, exercise can significantly increase HDL-C and improve TG levels, reduce dietary animal fat intake, and can reduce the prevalence of blood lipids.

6. Conclusions

This chapter describes the causative mechanisms of hyperlipidemia and how to prevent it from several aspects: diet, exercise, psychological factors, and lifestyle risk factors. The descriptions provide the reader with a better understanding of the importance of lifestyle interventions for improving and preventing hyperlipidemia on a daily basis. After the development of hyperlipidemia, it is even more important to strengthen and pay attention to the aforementioned aspects in daily life. Attention should be paid to actively adopting various lifestyle interventions, which can restore the body to a healthy condition.

Notes/thanks/other declarations

This study was funded by Liaoning Province Applied Basic Research Program [grant number 2023JH2/101300098].