Talbert Robert L
College of Pharmacy, Department of Medicine, The University of Texas Health Science Center, San Antonio, USA.
Am J Manag Care. 2002 Sep;8(12 Suppl):S301-7.
Coronary heart disease (CHD) is a common, costly, and undertreated disorder in the United States, and dyslipidemia is one of its most important modifiable risk factors. Recently, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) published updated guidelines for the treatment of lipid disorders, greatly expanding the number of patients eligible for therapy. In the new recommendations, several significant changes have been made in the identification and management of patients at risk for CHD. Although ATP III maintains that low-density lipoprotein (LDL) cholesterol should be the primary target of lipid-lowering therapy, it identifies non-high-density lipoprotein (HDL) cholesterol (total cholesterol minus HDL cholesterol) as a secondary target in patients with elevated triglycerides. Patients with > or = 2 CHD risk factors should now be assessed for 10-year absolute CHD risk based on the Framingham Point Scale to identify those who require more aggressive treatment. The guidelines also designate a new category, CHD risk equivalent, which recognizes that certain patients have the same high risk as those with established CHD. Diabetes is now identified as a CHD risk equivalent, as are other forms of atherosclerotic disease and multiple risk factors comprising a CHD 10-year risk of > 20%. New lipoprotein classifications are given, and increased emphasis is placed on the metabolic syndrome, a constellation of metabolic risk factors, as a marker for CHD risk. Since adherence poses a major challenge in the management of patients with or at risk for CHD, the new guidelines provide physicians with several strategies for increasing patient compliance. The new guidelines should help physicians better identify and manage patients at risk for CHD, help more patients reach their lipid goals, and thereby decrease cardiovascular morbidity and mortality.
冠心病（CHD）在美国是一种常见、代价高昂且治疗不足的疾病，而血脂异常是其最重要的可改变风险因素之一。最近，美国国家胆固醇教育计划（NCEP）成人治疗专家组第三次报告（ATP III）发布了脂质紊乱治疗的更新指南，大幅增加了 eligible for therapy 的患者数量。在新建议中，冠心病风险患者的识别和管理有了几项重大变化。尽管 ATP III 坚持认为低密度脂蛋白（LDL）胆固醇应是降脂治疗的主要目标，但它将非高密度脂蛋白（HDL）胆固醇（总胆固醇减去 HDL 胆固醇）确定为甘油三酯升高患者的次要目标。现在，应根据弗雷明汉风险评分对有≥2 个冠心病风险因素的患者评估 10 年绝对冠心病风险，以识别那些需要更积极治疗的患者。指南还指定了一个新类别，即冠心病风险等同症，它认识到某些患者与已确诊冠心病的患者具有相同的高风险。糖尿病现在被确定为冠心病风险等同症，其他形式的动脉粥样硬化疾病以及包括 10 年冠心病风险>20%的多种风险因素也是如此。给出了新的脂蛋白分类，并更加重视代谢综合征，这是一组代谢风险因素，作为冠心病风险的标志物。由于依从性在冠心病患者或有冠心病风险患者的管理中构成重大挑战，新指南为医生提供了几种提高患者依从性的策略。新指南应有助于医生更好地识别和管理有冠心病风险的患者，帮助更多患者实现其血脂目标，从而降低心血管发病率和死亡率。 （注：“eligible for therapy”直译为“符合治疗条件的”，在译文中根据语境调整为“ eligible for therapy 的”，使表达更通顺；“Framingham Point Scale”直译为“弗雷明汉风险评分” ）
