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[捷克动脉粥样硬化学会成人血脂异常诊断与治疗指南]

[Czech atherosclerosis society guidelines for the diagnosis and treatment of dyslipidemia in adults].

作者信息

Vaverková H, Soska V, Rosolová H, Ceska R, Cífková R, Freiberger T, Pit'ha J, Poledne R, Stulc T, Urbanová Z, Vráblík M

机构信息

III. interní klinika LF UP a FN, Olomouc.

出版信息

Cas Lek Cesk. 2007;146(6):II-XV.

Abstract

The present guidelines are based on the recommendations published in 2005 entitled "Prevention of Cardiovascular Diseases in Adulthood" summarizing the conclusions of nine Czech medical societies and agree with them in the assessment of individual risk of mortality from cardiovascular disease (CVD) according to SCORE tables. They reflect new research data in pathophysiology of dyslipidemias (DLP) and particularly the results of recent clinical trials of lipid-lowering therapy and their meta-analyses. They establish priorities for the screening and management of DLP, present suitable diagnostic methods, additional investigations of potential use in risk assessment, including some emerging risk factors and detection of sub-clinical atherosclerosis in persons in a moderate-risk category. Major changes include a lower LDL-cholesterol treatment target (< 2.0 mmol/L for all CVD individuals) and a possible use of apolipoprotein B as a secondary target in selected persons (< 0.9 g/L in high risk without CVD, < 0.8 g/L for CVD patients) and nonHDL-cholesterol (< 3.3 mmol/L in high risk without CVD, < 2.8 mmol/L for CVD patients). Therapy of individual DLP phenotypes (monotherapy and combination therapy) as well as basic principles for control examination at lipid-lowering medication are described. Recommended therapeutic lifestyle changes are shown. Enclosed are five annexes: DLP diagnosis; causes of secondary DLP; additional investiga- tions of potential use in risk stratification; familial hypercholesterolemia; list of recommended foods; two variants of SCORE tables for risk assessment for the Czech Republic; the scheme of recommended procedures and treatment algorithm in DLP asymptomatic individuals.

摘要

本指南基于2005年发表的题为《成人心血管疾病预防》的建议制定,该建议总结了九个捷克医学协会的结论,并在根据SCORE表评估心血管疾病(CVD)个体死亡风险方面与这些结论一致。它们反映了血脂异常(DLP)病理生理学的新研究数据,特别是近期降脂治疗临床试验的结果及其荟萃分析。它们确定了DLP筛查和管理的优先事项,介绍了合适的诊断方法、在风险评估中可能有用的额外检查,包括一些新兴风险因素以及对中度风险人群亚临床动脉粥样硬化的检测。主要变化包括降低低密度脂蛋白胆固醇治疗目标(所有CVD个体<2.0 mmol/L),以及在特定人群中可能将载脂蛋白B作为次要目标(无CVD的高危人群<0.9 g/L,CVD患者<0.8 g/L)和非高密度脂蛋白胆固醇(无CVD的高危人群<3.3 mmol/L,CVD患者<2.8 mmol/L)。描述了个体DLP表型的治疗(单药治疗和联合治疗)以及降脂药物控制检查的基本原则。展示了推荐的治疗性生活方式改变。随附五个附件:DLP诊断;继发性DLP的原因;在风险分层中可能有用的额外检查;家族性高胆固醇血症;推荐食物清单;捷克共和国风险评估的SCORE表的两个变体;DLP无症状个体推荐程序和治疗算法的方案。

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