Aronow W S
Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY and the Westchester Medical Center, Valhalla, NY 10595.
Am J Geriatr Cardiol. 2002 Jul-Aug;11(4):247-56. doi: 10.1111/j.1076-7460.2002.00816.x.
Older men and women with coronary artery disease, prior stroke, peripheral arterial disease, and extracranial carotid arterial disease with a serum low-density lipoprotein (LDL) cholesterol > 125 mg/dL despite diet should be treated with lipid-lowering drug therapy, preferably with statins, to reduce the serum LDL cholesterol to < 100 mg/dL. If statin drug therapy does not lower the serum LDL cholesterol to < 100 mg/dL in older persons with coronary artery disease, a bile acid binding resin, such as cholestyramine, should be added, since this drug does not increase the incidence of myositis in persons taking statins. The physician should use statins to treat older persons without atherosclerotic cardiovascular disease with a serum LDL cholesterol > or = 160 mg/dL plus one major risk factor, or a serum LDL cholesterol greater than or equal to 130 mg/dL plus a serum high-density lipoprotein (HDL) cholesterol < 50 mg/dL. Gemfibrozil may be useful in reducing the incidence of coronary events in persons with coronary artery disease whose primary lipid abnormality is a low serum HDL cholesterol level. There are no good data supporting treatment of hypertriglyceridemia unassociated with increased LDL cholesterol or decreased HDL cholesterol for prevention of cardiovascular disease.
患有冠状动脉疾病、既往中风、外周动脉疾病以及颅外颈动脉疾病的老年男性和女性，若血清低密度脂蛋白（LDL）胆固醇尽管经过饮食控制仍>125mg/dL，应接受降脂药物治疗，首选他汀类药物，以使血清LDL胆固醇降至<100mg/dL。如果他汀类药物治疗未能使患有冠状动脉疾病的老年人血清LDL胆固醇降至<100mg/dL，应加用一种胆汁酸结合树脂，如消胆胺，因为这种药物不会增加服用他汀类药物患者的肌炎发生率。对于没有动脉粥样硬化性心血管疾病但血清LDL胆固醇>或 = 160mg/dL且伴有一个主要危险因素，或血清LDL胆固醇大于或等于130mg/dL且血清高密度脂蛋白（HDL）胆固醇<50mg/dL的老年人，医生应使用他汀类药物进行治疗。吉非贝齐可能有助于降低原发性脂质异常为血清HDL胆固醇水平低的冠状动脉疾病患者的冠状动脉事件发生率。没有充分的数据支持对与LDL胆固醇升高或HDL胆固醇降低无关的高甘油三酯血症进行治疗以预防心血管疾病。
