Center for Preventive Cardiology, Division of Cardiology, University of Maryland Medical Center, Baltimore, MD 21201, USA.
QJM. 2009 Sep;102(9):657-67. doi: 10.1093/qjmed/hcp065. Epub 2009 Jun 4.
Strategies aimed at primary prevention provide an outstanding opportunity for reducing the onset and burden of cardiovascular (CV) disease. Lipid abnormalities, including high levels of low-density lipoprotein cholesterol (LDL-C), elevated triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C), are associated with an increased risk of CV events, thereby serving as contributors to this process. By consensus, lowering LDL-C, generally with statin therapy, is the primary target of lipid-lowering therapy. However, statin therapy may be insufficient for patients with mixed dyslipidemia, especially those with insulin resistance syndromes. While the addition of niacin, fibrate or omega-3 fatty acids may be useful in this setting, outcomes data are lacking. Therefore, data from ongoing prospective studies will hopefully resolve this issue and facilitate identification of optimal strategies to augment CV risk reduction.
旨在进行一级预防的策略为降低心血管(CV)疾病的发病和负担提供了绝佳机会。脂质异常,包括低密度脂蛋白胆固醇(LDL-C)水平升高、甘油三酯升高和高密度脂蛋白胆固醇(HDL-C)水平降低,与 CV 事件风险增加相关,从而成为这一过程的促成因素。通过共识,降低 LDL-C,通常采用他汀类药物治疗,是降脂治疗的主要目标。然而,对于混合性血脂异常患者,尤其是伴有胰岛素抵抗综合征的患者,他汀类药物治疗可能不够。虽然在这种情况下添加烟酸、贝特类或ω-3 脂肪酸可能有用,但缺乏结局数据。因此,正在进行的前瞻性研究的数据有望解决这一问题,并有助于确定增强 CV 风险降低的最佳策略。