Glassberg Helene, Rader Daniel J
Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Annu Rev Med. 2008;59:79-94. doi: 10.1146/annurev.med.59.121206.112237.
Lipid-modifying therapy has been proven to significantly reduce cardiovascular events and total mortality. Most of the data have come from statin trials. Statin therapy is generally well-tolerated and safe, and for patients who are at higher than average risk of cardiovascular disease, the benefit of lipid-modifying therapy far exceeds the risk. Careful risk assessment is a critical component of effective lipid-modifying therapy. In the foreseeable future, low-density lipoprotein cholesterol (LDL-C) will remain the primary therapeutic target, and combination therapy is likely to become the norm. The major questions are how low to treat and how to achieve increasingly aggressive targets in lipid-lowering therapy. Many patients on LDL-lowering therapy continue to have abnormalities of the triglyceride-high-density lipoprotein (TG-HDL) axis, so additional drug therapy is often considered for such patients. In this review, we briefly discuss new developments in cardiovascular risk assessment, then discuss recent developments in treatment to reduce LDL, and finally discuss current concepts regarding therapy targeting the TG-HDL axis.
脂质修饰疗法已被证明可显著降低心血管事件和总死亡率。大部分数据来自他汀类药物试验。他汀类药物治疗一般耐受性良好且安全，对于心血管疾病风险高于平均水平的患者，脂质修饰疗法的益处远超过风险。仔细的风险评估是有效的脂质修饰疗法的关键组成部分。在可预见的未来，低密度脂蛋白胆固醇（LDL-C）仍将是主要治疗靶点，联合治疗可能会成为常态。主要问题是治疗到多低的水平以及如何在降脂治疗中实现越来越严格的目标。许多接受LDL降低治疗的患者的甘油三酯 - 高密度脂蛋白（TG-HDL）轴仍存在异常，因此这类患者常考虑加用其他药物治疗。在本综述中，我们简要讨论心血管风险评估的新进展，然后讨论降低LDL治疗的最新进展，最后讨论针对TG-HDL轴治疗的当前概念。
